John Cornyn

Mr. CORNYN

Mr. CORNYN. The following Senator is necessarily absent: the Senator from Arizona (Mr. McCain). Further, if present and voting, the Senator from Arizona (Mr. McCain) would have voted ``yea''.

Mr. CORNYN. Mr. President, reserving the right to object. The Senator from New Hampshire has acknowledged that she had made this previous request last week. The Kaiser Family Foundation, among other publications, has clearly stated that the cost-sharing reductions she is asking for are paid directly by the Federal Government to insurance companies. Thus, when I call this an insurance company bailout, I believe that is literally true. The Congressional Budget Office estimates the cost of these payments at $7 billion in 2017, $10 billion in 2018, and $16 billion by 2027. So what my friend, the Senator from New Hampshire, is proposing is an insurance company bailout in the tens of billions of dollars with no reform, throwing more money at a broken Affordable Care Act, which has been in existence 7 years now. I know they would like to blame this on President Trump, who has been in office just a short time--about a half a year--but this is built into the very structure of the Affordable Care Act, and it isn't working. I, personally, will not be part of any bailout of insurance companies without reforms. That is why we were trying to structure something under the Better Care Act, which unfortunately we haven't been successful with so far. We are going to keep on trying, but this is not the answer. I object.

Mr. CORNYN

Mr. CORNYN. Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. CORNYN. Mr. President, after weeks--make that months, make that years of discussions about the path forward to rescue the American people from ObamaCare, we find ourselves at an important fork in the road. We have talked among ourselves about the necessity of keeping our promises to repeal and replace ObamaCare. We are coming down to the reality that, without the Democrats being willing to participate in the process and given the strictures of the budget reconciliation process, it is not going to be possible for us to do as much as we would like to do. We will continue to talk, and my hope is that we will continue to make progress with some sort of consensus on how best to proceed. In the meantime, we do have a bill that 51 Republicans voted for in 2015 to repeal ObamaCare and leave 2 years available for a transition on a bipartisan basis. Here is my concern. Under ObamaCare, there are massive amounts of money being paid to insurance companies for something called cost sharing in order to try to help bring the premiums down, in order to try to help bring the deductibles down to make them affordable. It is pretty clear it is not working, given the 105-percent increase in premiums since 2013 alone under ObamaCare. Right now, we know the individual market, which is the insurance market where individuals and where small businesses buy their health insurance, is in a meltdown mode. That is after 7 years of ObamaCare. Our friends across the aisle would like to convince you that in the 6 months or so President Trump has been in office, he has been the cause of that. It is not true. Many of us, myself included, would love to see us stabilize the individual insurance market while we get some important reforms done to try to help bring premiums down in order to reassure people that we are going to protect preexisting conditions and while we do some additional important work on Medicaid reform. I would be lying if I said that this is easy. Frankly, people didn't send us here to do easy stuff. They sent us here to do the hard stuff, and we need to continue to use our best efforts to keep our commitments and to deliver something better than the broken status quo of ObamaCare. My concern is, if we are unsuccessful in doing that--we have already seen, for example, our friend, the distinguished Senator from New Hampshire, propose some additional mandatory cost sharing for insurance companies. According to the Kaiser Foundation, these are direct payments from taxpayers to insurance companies. Rather than working with us to try to make a course correction in ObamaCare and to put it on a sustainable path--our friends across the aisle want none of that. What they want is the cash. They want the billions of dollars that are going to go to insurance companies and no reform. I personally find that to be an unacceptable alternative. We do need to do something to protect people who are being hurt right now from the sky-high premiums and the deductibles that render their health insurance unaffordable. My concern is, to be absolutely candid with you, right now the President is authorizing on a month-to-month basis the cost-sharing payments, which are sustaining the market as it currently is--not well enough, given the structural problems, but at least keeping some insurance companies available in most places, although not all. My concern is, unless we pass something like the Better Care Act, we are left with an untenable alternative. The President's statement that he may decide not to make those cost-sharing payments would provoke an immediate crisis in the marketplace, which would force us to act. I don't think that is inherently bad, but I want to make sure that we act in a constructive way, that we are not just throwing billions more dollars at a broken system, but that we actually implement the reforms to put it on the right path. I know in Washington people tend to think in terms of Republicans and Democrats, and this is all about Obama, this is about Trump, this is about personalities. It is not. It is not even about politics. It shouldn't be, ultimately. This should be about the people we represent in our States and the people we represent across the country. How can we do the best job, given the difficult hand we have been given, to try to help make things better? This is not going to be the end of the process. This is another step along the journey toward helping to make healthcare more affordable and more accessible. There is a lot of great work that has been done. As the Presiding Officer knows, he has been at the forefront of trying to make sure we address things like the opioid crisis, which is devastating communities across the country. I was here showing a chart yesterday that the Presiding Officer has seen, showing HIV deaths going way down thanks to modern drugs, car wrecks were still in the 30,000 range, but deaths as a result of overdoses were up around 52,000 a year, I think, is the rough number. That is a public health crisis. We need to do everything we can to make sure we are delivering services to the people who need it most who are suffering, but if all we do is bail out insurance companies, we will not have done our job, especially toward the communities hurt by the opioid crisis. We are going to continue to work, but at some point we are going to have to vote, and, yes, people are going to have to be put on record. Now, we are all grownups. Most of us have held political office for a fair time now. We know how to explain our votes to the voters back home, to whom we are accountable. If you don't vote, then nobody is accountable, and everybody can blame each other for the outcome. I really do worry, unless we redouble our efforts to come up with meaningful reforms to the broken ObamaCare system, that we will be left with an untenable choice, either an insurance company bailout of the same flawed structure of ObamaCare or an immediate crisis that is going to force us to act and do the bailout without any reforms. Mr. President, the other thing I just want to point out, in the closing minutes I wish to speak, is the process by which our Democratic friends have dragged their heels to the point of almost bringing this place to a halt, particularly when it comes to a new President getting votes on his nominees for Cabinet positions and sub-Cabinet positions. They are the first to criticize the President for not getting things done that he wants to get done, but when they sabotage his ability to try to populate these important positions in the Cabinet and sub- Cabinet positions by dragging their heels on nominations, they are causing a large part of the problem. To put this in perspective, in 2009, 90 percent of President Obama's confirmations happened by voice vote. That is without a recorded vote, and that is without 30 hours expiring after voting and closing off the debate. This was just essentially an agreement in 90 percent of the cases. Democrats in the Senate under the Trump administration have allowed only 10 percent of his nominees to be voice-voted. We allowed 90 percent for President Obama. We didn't agree with President Obama on a lot of things, but we agreed that he won the election, and he was entitled to populate his Cabinet and sub-Cabinet with people of his choice, assuming they weren't disqualified for some other reason. Well, this week, we have considered Patrick Shanahan, nominated to be Defense Secretary of the Department of Defense, which is a role vitally important to the Department as it works through readiness, modernization, and of course the service to our men and women in uniform, providing them the tools and equipment and the training they need in order to protect the country. In order to accomplish that, the Defense Department needs a full team. We spend more than $600 billion a year on national defense, and yet the President can't get his full team put in place on a timely basis because of partisan foot-dragging. Well, it serves another purpose, I suppose, because the more we are tied up on nominations, the less time we have to deal with legislation. These kinds of tactics remind me of the former majority leader, Harry Reid, whose political schemes cost his party a 60-vote, filibuster- proof majority. I know the distinguished senior Senator from New York, my friend, the Democratic leader, remembers that when Members of his own party can't bring back home any record of accomplishment for what they have done during their time here in Washington, it is pretty hard to make the case you should be reelected. After Harry Reid blocked participation, not just from the minority but also from the majority so they couldn't go back home and demonstrate that they had fought and accomplished things for their constituents, their party suffered a very tough political price. So I would urge our colleagues to end this perpetual obstruction on nominations, legislation, and everything else. Noncontroversial nominees should not require days to get confirmed or judges, for that matter, should not require a 30-hour postcloture vote in order to get confirmed by more than 90 votes. That indicates it is not a controversial vote so why burn up the time except out of spite or desire to slow down this administration or this Congress in terms of getting things done. The American people sorely want leaders at every level of our government. They are hungry for us to lead and to demonstrate we are listening to them and doing what we believe to be in their best interest, and they deserve a Senate that fulfills one of our most fundamental responsibilities, which is to consider and vote on Presidential nominees. I yield the floor. I suggest the absence of a quorum.

Mr. CORNYN

Mr. CORNYN. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. CORNYN

Mr. CORNYN. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. CORNYN

Mr. CORNYN. Mr. President, on Thursday, after two additional weeks of consultation and input from Senators, we released an improved version of the bill we call the Better Care Reconciliation Act, which represents our efforts to address the failing status quo of ObamaCare. We have said all along that even if Hillary Clinton were elected President, we would have to revisit ObamaCare because we have seen in a number of States that insurance companies are fleeing, leaving people with few, if any, options. People in the individual and small group market are seeing their premiums skyrocket 105 percent, nationwide, since 2013 alone--a 105-percent increase in premiums. For many of these folks, even though they paid the higher additional premium, their deductibles are so high that, effectively, they are being denied the benefit of any insurance whatsoever. I guess, perhaps, it is no surprise that 28 million Americans would simply be willing to pay the fine that goes along with the individual mandate for not buying government-approved health insurance or claim some sort of hardship exemption. ObamaCare was sold under the premise that, if you like your policy, you can keep your policy, and, if you like your doctor, you can keep your doctor and, oh, by the way, your premiums are going to go down $2,500, but what people have experienced has been the opposite of that, with premiums going up on average $3,000. We simply believe that we have to act to save the millions of people who are being hurt by the status quo. That would be true whether Hillary Clinton were President or Donald Trump were President. Our first goal in the Better Care Reconciliation Act is to stabilize the insurance markets, to make sure that people actually have an insurance company they can buy from. Our second goal is to get premiums down. The reasons premiums are not down are mainly twofold. One is that you have younger, healthier people simply forgoing insurance, leaving only sicker, older people in the risk pools. Under adverse selection, that means everybody pays higher premiums when younger, healthier people simply don't purchase the product because they can't be part of that risk pool. The second reason why premiums are so high is the mandates. People are simply being ordered by their own government to buy coverage they don't want or need, which drives up premiums, not to mention the fact that young people are subsidizing older people's health insurance premiums the way that ObamaCare was constructed. We are going to do everything we can to get the premiums down. The first Congressional Budget Office report said that long term you would see premiums go down by as much as 30 percent by the year 2020, but we want to do even better than that if we can. The third thing we said we wanted to do was that we wanted to protect people with preexisting conditions. When people are forced to keep a job they really don't want because they don't want to lose their employer-provided health coverage due to preexisting conditions, we don't want people to be stuck at a job they don't want or be unable to quit their job and look for something else because they are worried about not being covered due to preexisting condition exclusions. We maintain the current status of the law with regard to protecting people with preexisting conditions. The fourth thing that we try to do in this bill is that we try to take one of the large entitlement programs, Medicaid, which is an important safety net for low-income Americans, and we put it on a sustainable path. There are some people who think you can spend hundreds of billions of dollars more for Medicaid over time and we can continue to deliver those services to the poor people in our country, and we don't need to worry about crowding out defense spending or education or some other priority. We simply cannot do it. What we have done is put it on a responsible growth rate and delegate more of that authority to the States to come up with innovative programs. Our plan will remove costly mandates and will help provide more options and drive down some of the exorbitant costs. We will soon have a chance to rescue the American people from the failures of the ObamaCare experiment. This is a critical moment for the Senate. I want to go over a few updates to the discussion draft, perhaps in the hopes that some of my colleagues on both sides of the aisle will realize that, when faced with the choice of our reform plan or the status quo, the choice is clear. After listening to a number of Senators, we made some important updates. For example, to combat the opioid epidemic that is ravaging the country, our new draft includes an additional $45 billion for substance abuse and recovery. As this chart indicates, the number of people with HIV has gone down to 6,400, thanks to innovations and drug therapy, principally. As to car accidents, 37,000 people a year die in the United States as a result of car accidents, but 52,000 people--and growing--lose their lives due to opioid and other drug overdoses. This is an epidemic that has to be dealt with. The abuse of heroin and prescription painkillers is devastating families and communities all across the country, but, particularly, we hear from our colleagues in Ohio, West Virginia, and Kentucky that this is an urgent and unmet need. These additional resources will be critical for providers, for advocates, and for families on the front lines of this crisis. As I said, our colleagues from Ohio, West Virginia, New Hampshire, and other places advocated for something called the Comprehensive Addiction and Recovery Act last year, which we were able to pass to address this crisis, and we passed additional legislation called the 21st Century Cures Act in December, which, again, added additional resources. But this represents the single largest allocation or appropriation of Federal dollars to deal with this crisis than has ever occurred before. I think it is because it is necessary, and I thank our colleagues for bringing this to our attention. This is a shocking statistic, when you think about it--that more people die of drug overdoses in America today than die in car accidents--and we are going to do something about that in this legislation. We are also introducing a provision that, for the first time, would allow people to use pretax dollars to pay for their insurance premiums. Let's say you paid 25 percent of your income to taxes. If you can use pretax dollars, then, basically, that effectively lowers your out-of- pocket cost if you can use pretax dollars rather than the net of tax. We expand the use of health savings accounts to give people that ability, which effectively lowers the cost of their premiums, again, and provides them more flexibility in terms of determining how to provide for their healthcare. Some people may decide--and we want to give them the freedom to do so--to say: Maybe, all I need is a hospitalization policy in addition to a health savings account, where I will put pretax dollars in there and save them and use those to pay for doctors' visits. That is the kind of thing that we have seen in States like Indiana and elsewhere, which have been used very effectively to provide additional choices for consumers and their physicians on how they address their healthcare needs and their costs. As I say, allowing consumers to use pretax dollars to pay for their health insurance premiums will help bridge the coverage gap. Both the Congressional Budget Office and the Joint Committee on Taxation have affirmed that this will help boost access to healthcare coverage. Another improvement this latest discussion draft brings forward is more options to buy lower premium plans. Under the Better Care Act, anyone in the individual market is allowed to purchase a lower premium health insurance plan, like the one I mentioned. While those plans have lower monthly costs with a higher deductible, they will still cover up to three primary care visits a year and, ultimately, limit an individual's out-of-pocket costs. Coupled together with the health savings account, this may well be the most affordable way for people to address their healthcare. Not everybody is the same. That was part of the problem with ObamaCare. It treated us all like we were widgets and not human beings with unique needs, depending on our family circumstances or our health condition or what part of the country we lived in. This allows people to personalize and individualize their own healthcare plan. I think this is great news for otherwise healthy adults previously barred from purchasing these plans under ObamaCare. Young people, whom we need in the insurance pool in order to bring down premiums for everybody else, don't want to have to subsidize older folks' health coverage. They want to pay the freight for their own costs, but this will allow them access to a lower cost plan that will allow them to be covered for an unexpected hospitalization or other catastrophic event. In addition to this freedom of choice, these plans will now also be eligible for tax credits. In other words, what we provide is a refundable tax credit, which essentially is a check from the Federal Government to the insurance company to pay your health insurance premium. Under ObamaCare, people enrolled in these sorts of catastrophic plans were prohibited from receiving tax credits like the ones we are offering, even when they met all other eligibility requirements. That doesn't make any sense, and our legislation fixes that. We have also made several revisions to Medicaid. I might mention that there is a lot of discussion about whether we are cutting Medicaid. I have said before that only in Washington, DC, can you spend more money year after year and be accused of cutting. Honestly, fairly, what we do is to reduce the rate of growth for Medicaid, this uncapped entitlement program that contributed more than $20 trillion to the national debt. We put it on a reasonable budget and a rate of growth. Actually, from the beginning until the end, we will see Medicaid spending go up by the Federal government by $71 billion. Ultimately, for Medicaid to work more efficiently for the people it is intended to serve--primarily, the children, the blind, the disabled, and the elderly frail--we need to give the States more flexibility to implement Medicaid spending based upon the unique needs of people in their States. One of the big problems with ObamaCare is that it expanded Medicaid to otherwise healthy adults. We have a better way to deal with that, using the tax credit, the State innovation and stability funds, and something called the 1332 waivers, where the Centers for Medicare and Medicaid Services essentially is giving the States the opportunity to innovate and use the money and the tax credit to come up with something that suits the needs of their population. Really, what we need to do is to get Medicaid focused again on the most vulnerable populations, which are the disabled, the blind, the frail elderly, and children. To improve the management of vulnerable populations such as this, now States can apply for a waiver to utilize existing funds as they see fit to improve community-based services that these folks rely on. Our Medicaid provisions allow the States flexibility to route funds to regions impacted by public health emergencies, which include disastrous weather events like hurricanes. Instead of being applied as a block grant or based on per capita caps, under our legislation, emergency funding will be applied where and when it is needed. Lastly, under our Medicaid revision, States can add expansion populations under existing block grants if they choose to do so. Medicaid will always be as it has been--a Federal-State shared expense. By allowing States to be flexible in their Medicaid application, we can help them fill the gaps that the mandates under ObamaCare chose to merely gloss over. For example, in Texas, we were not a Medicaid expansion State. So young adults between 100 percent of poverty and 138 percent of poverty will now get access to a tax credit with the innovation and stability funds and these waivers, which will allow them, for the first time, to get access to private health insurance. That is good for them, and I think represents a vast improvement on the status quo--about 600,000 in Texas alone. Our new draft includes an additional $70 billion to encourage States and help them implement these new reforms. What I have come to learn is, people don't really trust Washington, DC. Certainly, based on the experience of ObamaCare--this failed experiment where people were promised certain things that ended up not being true and created the problems we now are having to fix--I think people will have a lot more confidence in a plan that lets the Governors and lets the State leaders manage this money and address the healthcare needs of their population by people who are closest to those people rather than out of Washington, DC. Our bill does that in a dramatic way. It takes that authority and power grabbed by ObamaCare and gives it back to the Governors and the States to manage. Based on the polling I have seen, people certainly have greater confidence in the States and their leadership at the local level to deal with this than they do under ObamaCare. If Governors want to try to come up with unique healthcare products to drive down premiums, cost sharing, or increased funding for health savings accounts, this legislation gives them greater flexibility and gives them additional funding through the Innovation and Stability Fund to do just that. Many of us have quoted Louis Brandeis, who served on the U.S. Supreme Court, who said: States are the ``laboratories of democracy.'' It is true. You don't see any innovation at the Federal level. It is more like dealing with the Politburo. It is all command and control--central planning, which we know doesn't work very well. The States are the laboratories of democracy. If we give them the freedom to innovate and the resources to do so, I think we can expect our healthcare system to move forward. Soon we are going to have a critical vote, one that has been 7 years in the making. While our plan is not perfect, it is certainly better than the status quo, which is why we call it the Better Care Act. This is not the end, as Dr. Tom Price, of Health and Human Services, points out. This is just the next step. We know we are going to have other opportunities to address healthcare, most notably in September, when we reauthorize the Children's Health Insurance Program, but this, by any measure, represents an improvement over the status quo. I think there are some very useful parts of this bill that people will like if they look at it objectively and consider it fairly, but if we don't take up the bill, well, it can't be changed, and millions of Americans will continue to be harmed by the status quo. That is a decision we all have to make when we move to the bill. Do we have enough confidence that we can make it better or are we simply going to throw our hands up and say, ``Well, I give up,'' before we even start, leaving people with the failure of the status quo? I would like to encourage our colleagues to work with us to make this legislation better. It is unfortunate that healthcare has become such a polarizing and partisan issue. It doesn't need to be that way, but it started off with ObamaCare, which was passed along purely party lines, creating a situation where there is not bipartisan support for healthcare, generally, which is a real tragedy, given the importance this has to all of us and all of our families. Given the hand we have been dealt, we are going to plow ahead and do the best we can. I sat down at my computer this morning, and I started to write a list of things I liked about the Better Care Act that perhaps most people haven't heard much about. No. 1, it repeals the individual mandate. This is the fine that has been imposed on people for not buying government-approved health insurance. It repeals the job-killing employer mandate. This bill will lower premiums, repeal burdensome taxes, and restore choices. It will help stabilize insurance markets and protect people with preexisting conditions. It will allow people to use pretax dollars to pay for their healthcare costs, including insurance premiums. It provides substantial resources to fight opioid and other substance abuse. It provides better quality coverage to low- income Americans that will improve medical outcomes for low-income Americans, and it puts Medicaid on a sustainable path. I would like to encourage all of our colleagues to work with us to help make this legislation even stronger. Everybody will be able to offer an amendment and get a vote on the amendment when this bill comes to the floor. I believe the alternative is a disaster for our country, and we simply can't afford to let it stand. Mr. President, I yield the floor.

Mr. CORNYN

Mr. CORNYN. The following Senators are necessarily absent: the Senator from Iowa (Mrs. Ernst), the Senator from Arizona (Mr. Flake), the Senator from Nevada (Mr. Heller), the Senator from Arizona (Mr. McCain), the Senator from Mississippi (Mr. Wicker). Further, if present and voting, the Senator from Iowa (Mrs. Ernst) would have voted ``yea'' and the Senator from Mississippi (Mr. Wicker) would have voted ``yea''.

Mr. CORNYN

Mr. CORNYN. Mr. President, I reserve the right to object. I wonder if the Senator from New Hampshire would allow me to pose a question about her request?

Mr. CORNYN. Is it true that under the so-called Marketplace Certainty Act, this would appropriate billions of additional dollars to insurance companies?

Mr. CORNYN. Mr. President, I appreciate the response from the Senator from New Hampshire. I think I want to explore that a little more. I don't think the cost-sharing subsidies go directly to beneficiaries but, rather, to insurance companies. Nevertheless, this is exactly the kind of proposal that the Senate can vote on next week when we proceed to the healthcare bill. As we know, unlike traditional legislation, there is an open and unlimited amendment process, and Members on both sides will have a chance to offer amendments and have the Senate vote on them. So I would encourage all of our colleagues who have ideas about how to shape the healthcare policy to vote to get on the bill and then to offer amendments. It has been 7 years since ObamaCare was passed. It is in meltdown mode. We are glad to have our colleagues across the aisle offer suggestions on how to improve the current terrible situation for so many millions of people, but I must object.

Mr. CORNYN

Mr. CORNYN. The following Senator is necessarily absent: the Senator from Kansas (Mr. Moran). Further, if present and voting, the Senator from Kansas (Mr. Moran) would have voted ``yea.''

Mr. CORNYN

Mr. CORNYN. Mr. President, as we continue to discuss the Better Care Act, which is an alternative bill that we will propose next week and vote on, which takes the disaster known as ObamaCare which for millions of Americans has led to sky-high premiums and unaffordable deductibles, if they can even find an insurance company that will sell them an insurance product--we will propose a better care act, as we call it, not a perfect care act but a better care act. It would be even better if our Democratic colleagues would join us and work with us in this effort, but as we have come to find out, they are unwilling to acknowledge the failures of ObamaCare. So we are forced to do this without their assistance. It would be better if it were bipartisan, if they would work with us, but they have made it very clear that they are not interested in changing the broken structure of ObamaCare. What I predict is that what they would offer is an insurance company bailout, throwing perhaps hundreds of billions of dollars at insurance companies in order to sustain a broken ObamaCare that will never work--no matter how much money you throw at it. So people will continue to suffer from the failures of ObamaCare unless we will have the courage to step forward and to say we are going to do the very best we can with the tough hand we have been dealt to help save the American people who are being hurt right now. Basically, there are four principles involved. One is we want to stabilize the individual insurance market, which is the one that insurance companies are fleeing now because they are bleeding red ink. They can't make any money, and they are tired of losing money so they basically pull their roots up and leave town, leaving customers in the lurch. Secondly, we want to make sure we actually lower insurance premiums. Under the original discussion draft bill that we introduced about a week or so ago, the Congressional Budget Office said we will see premiums go down as much as 30 percent over time. Now, I wish I could say we were going to be able to have an immediate effect on those premiums, but the truth is this is much better than our friends across the aisle have offered us with the offer to basically sustain a broken ObamaCare system. The third thing we want to do is protect people who might have their health insurance hurt or impeded by preexisting conditions. We want to maintain the current law so people are protected when they leave their work or when they change jobs. The fourth is, we want to put Medicaid on a sustainable path. Medicaid is one of the three major entitlement programs, and now we spend roughly $400 billion on Medicaid in this country. Our friends across the aisle don't want to do anything that would keep that from growing higher and higher and higher, to the point where basically the system collapses. We believe that is not the responsible choice. What we propose is to spend $71 billion more on Medicaid over the budget window and to work to transition those States that have expanded Medicaid and offer their people a better option in the private insurance area, but I just want to mention that I have shared a number of stories about, for example, a small business owner in Donna, TX, who was forced to fire their employees so they could afford to keep the doors open and provide health insurance for the remaining people. You have to ask: What in the world could lead us to a system which would discourage people from hiring more folks and basically put them in a position where they had to fire them in order to make ends meet? But that is what the employer mandate did under ObamaCare. If you have more than 50 employees, you are subject to the employer mandate. You get punished unless you make sure your employees are covered with insurance, and many times it is unaffordable so it had the perverse impact of small businesses saying: We can't afford to grow the number of people who are working in our business or we are going to need to shrink it in order to avoid that penalty. Stories like this remind me of just how important our efforts are to repeal and replace ObamaCare. The status quo is not working. In fact, every year ObamaCare gets worse for the millions of people in the individual market in particular. It is important that ObamaCare is not just about insurance. ObamaCare is about penalties that are being imposed on businesses that hurt their ability to grow and create jobs. That is one reason I believe that since the great recession of 2008, where ordinarily you would see a sharp bounce up in the economy, that the economy has been largely flat and has not been growing, in part, because of the penalties, mandates, and regulations associated with ObamaCare. Not only has ObamaCare made health insurance more expensive while taking away choices, it also has compounded fundamental problems with important safety net programs like Medicaid. I wish to share a story from an emergency room employee in Lake Granbury, TX, who wrote to me about the alarming trend she has noticed in the hospital where she works. She says, because fewer and fewer physicians will see a Medicaid patient, she has seen an influx of these Medicaid patients who ostensibly have coverage coming to the emergency room for their primary care. As she points out, this is not a good situation for patients and hospitals. In my State, according to the latest survey of the Texas Medical Association that I have seen, only 31 percent of doctors in Texas will see a new Medicaid patient. That may sound crazy, but let me explain why. Because Medicaid basically pays a physician about half of what private insurance pays when it comes to see a patient, many of them simply say: Well, I can't afford to see a lot of Medicaid patients. I need to balance that or at least make sure I see enough private insurance patients to make sure I can keep the doors open and meet my obligations. What happens when fewer and fewer doctors actually see Medicaid patients is, people end up showing up in the emergency room for their primary care because they can't find a doctor to see them. The truth is, medical outcomes based on many studies that have been done in recent years are that Medicaid coverage in those instances can be no worse and no better than not having insurance at all. ObamaCare was put in place ostensibly to avoid reliance on emergency rooms for access to care, but as we all know, ObamaCare hasn't lived up to many of its promises and unfortunately making stories like this one commonplace. I mentioned this earlier, but just to see the trend line, in 2000, 60 percent of Texas physicians accepted new Medicaid patients; today that number is 34 percent. I think I may have earlier said 31 percent. It is actually 34 percent, due to lower rates of provider reimbursement, leaving places like Lake Granbury in the lurch and causing them to have to turn to the emergency room for their primary care as a last resort. Every 2 years, Texas doctors fight with the Texas legislature to raise payments for the Medicaid system, but the reality is, there is not enough money to go around, even though it is the No. 1 or No. 2 budget item in the Texas legislature's budget every year, and it is growing so fast it is crowding out everything from higher education to law enforcement and other priorities. Across the country, Medicaid spending has ballooned out of control. In Texas, 25 percent of the State's budget, as I indicated, is dedicated to this program, 25 percent of its overall budget--usually No. 1 or No. 2. So we have to be honest with ourselves and the people we represent that this situation is not sustainable. We owe it to the millions of people to make sure the people who really need it--the fragile, elderly, disabled adults and children--that it is there for them, not only now but in the future. That is why we have been discussing ways we might strengthen the sustainability of Medicaid to ensure that families who actually need it can rely on it, and they don't have the rug pulled out from under them. This requires doing some hard work of reforming the way States handle Medicaid funding. For example, Medicaid, as is currently applied, States are only allowed to review their list of Medicaid recipients once a year, but a lot can happen in a period of a year. Somebody can get a job, and they may be no longer eligible based on the income qualifications for Medicaid. If they can only check once a year, then people remain on the rolls, even though they may no longer qualify. Regardless of whether somebody gets a job or moves or passes away or no longer needs Medicaid, they are still in the system, and there is nothing the States can do about it. We would like to change that. While it sounds like a simple matter, when the average Medicaid patient costs the State more than $9,000 each and as high as almost $12,000 per elderly individual, it adds up. One of the things we saw that ObamaCare did in the States that expanded Medicaid coverage is that those States decided to cover single adults who are capable of working. This bill would also allow States to experiment with a work requirement as part of the eligibility for Medicaid. We are not mandating it, saying they have to do it, but if the State chooses to do it, then they can do so. We need to give the States the flexibility they need so they can use the Medicaid funding they have more efficiently so more people can get access to quality care. I want to be clear: 4.7 million Texans rely on Medicaid. Of course, those rolls tend to churn based on people's employment and their family circumstance, but it is not going anywhere. We want to make sure we preserve Medicaid for the people who actually need it the most. We are working to make it stronger, more efficient, and, yes, more sustainable. I guess some people live in a fantasy world, where they think we can continue to spend money we don't have and there will never be any consequences associated with it. The fastest items of spending in the Federal budget are entitlement programs including Medicaid. Right now we are at $20 trillion. We have done a pretty good job--I know we don't get much credit for it--we have done a pretty good job of controlling discretionary spending, but the 70 percent of mandatory spending, including Medicaid, has been going up, on average, about 5.5 percent a year. That can't happen in perpetuity. Right now, we know we have $20 trillion, roughly, in debt--$20 trillion. It is frankly immoral for those of us who are adults today to spend money borrowed from the next generation and beyond because somebody ultimately is going to have to pay it back, and it is going to have real-world consequences. We know that since the great recession, the Federal Reserve has kept interest rates very low through their monetary policy, but we know as well that as the economy tends to get a little bit better and unemployment comes down, they are going to begin inching those interest rates up little by little, which means we are going to end up paying the people who own our debt, our bondholders, more and more money strictly for the purpose of giving them a return on their investment for the debt they buy. This is an opportunity for us not only to put Medicaid on a sustainable path, to do the responsible thing, to give the States ultimate flexibility in terms of how they handle it, it is also a matter of keeping faith with the next generation and beyond when it comes to this unsustainable debt burden. I hear people talk about slashing Medicaid despite the fact that the Congressional Budget Office estimates that Medicaid spending will grow by $71 billion over the next 10 years. Only in Washington, DC, is that considered a cut, where spending next year exceeds what it is this year and the next and so on, and it goes up by $71 billion. Yet you will hear people come to the Senate floor and say that is a cut and that we are slashing Medicaid. It is nothing of the kind. To me, the choice is clear. Do we want to continue with the failures of ObamaCare or do we want to do our very best to try to provide better choices and better options? Do we want to continue to allow the status quo, which is hurting families, putting a strain on doctors and our emergency rooms and hospitals like I mentioned in Lake Granbury or do we actually want to address the fundamental flaws of our healthcare system? I wish we could do something perfect, but certainly with the constraints imposed by the fact that our Democratic friends are not willing to lift a finger to help, and given the fact that we have to do this using the budget process--those are some pretty serious constraints. We basically have to do this with one arm tied behind our back, but we are going to do the best we can because we owe it to the people we represent. I encourage our colleagues on both sides of the aisle to try to take a fresh look at this and figure out how we can be part of the solution, not just to compound the problem. There is one thing I haven't mentioned that I am particularly excited about in the Better Care Act; that is, for States like Texas that did not expand Medicaid to cover able-bodied adults in the 100 to 138 percent of Federal poverty level, in the Better Care Act, we provide them access to private health insurance coverage and access for the first time. About 600,000 Texans--low-income Texans--who, for the first time under the provisions of this bill, will have access to a tax credit, and States, using the Innovation and Stability Fund and something called the section 1332 waivers, will be able to design programs which will make healthcare more affordable in the private insurance market. One reason people prefer the private insurance market to Medicaid is for the reason I mentioned earlier, that Medicaid reimburses healthcare providers about 50 cents on the dollar compared to private health insurance. This actually will provide them more access to more choices than they have now, certainly. Certainly, for that cohort of people between 100 percent of Federal poverty and 138 percent of Federal poverty in those States that didn't expand. I am excited about what we are trying to do here and its potential. Again, to stabilize the markets, which are in meltdown mode right now and we all know are unsustainable, our friends across the aisle will say: We will talk to you if you take all the reforms off the table, which translates to me: We will talk to you about bailing out a bunch of insurance companies but doing nothing to solve the basic underlying pathology in the system. So we are going to do that in our bill, the Better Care Act. Secondly, we want to make sure that we do everything in our power to bring down premiums. I know the Presiding Officer cares passionately about this. This may well be the litmus test for our success. Under the discussion draft we released earlier, the CBO said that in the third year, you could see premiums as much as 30 percent lower, but we would like to see even more choices and premiums lower than that and more affordable. The third thing our Better Care Act will do is to protect people against preexisting conditions. Right now, people sometimes refuse to or are afraid to leave their jobs in search of other jobs because, if they have preexisting conditions, then they cannot get coverage with the new insurance companies for a period of time. That is called the preexisting condition exclusion. We would like to protect people against that eventuality so that people do not have to be worried about changing jobs or losing their jobs and losing their coverage. Fourth, as I have taken a few minutes to talk about here today, we want to put Medicaid--one of the most important safety net programs in the Federal Government--on a sustainable path, one that is fair to the States that expanded Medicaid under the Affordable Care Act and to those that did not. I think any fair-minded person who is looking at what we have proposed here would agree with me that it is not perfect but that it, certainly, fits the name that we have ascribed to it. It is a better alternative than people have under the status quo. I urge all of our colleagues to work with us in good faith to try to improve it. Here is the best news of all, perhaps, to those who would have other ideas. We do have an opportunity to have an open amendment process, and sometimes that does not happen around here. People say: Here it is. Take it or leave it. You cannot change it. All you can do is vote for it or vote against it. That is not what we are going to do. We are going to have an open amendment process. As long as Senators have the energy to stay on their feet and offer amendments, they can get votes on those amendments. I cannot think of a better way to reflect the will of the Senate and to come out with the very best product that we can under the circumstances. We are on a trajectory next week to begin this process and will have, probably, some very late nights and early mornings come Thursday and Friday. I yield the floor. I suggest the absence of a quorum.

Mr. CORNYN

Mr. CORNYN. Mr. President, as we move forward in our efforts to repeal and replace the failed ObamaCare law, it is worth remembering the reasons why this work is so urgent and why it is so important. The Affordable Care Act has left many American families paying far more for healthcare than they did beforehand, and it has taken away their freedom to choose the doctor they want or the health plan they want. That is, of course, all contrary to what was promised at the time ObamaCare was passed back in 2009 and 2010. We all remember what the President said, and none of it has proven to be true in terms of your plan, your doctor, or the costs. In fact, as I mentioned before, the cost has gone up 105 percent for people in the individual market since 2013 alone. So rather than seeing a $2,500 decrease in the cost to their health coverage, they have seen a $3,000 increase, and the prices continue to go up. It is actually getting worse by the day, which is another reason for the urgency of what we are about to do. A report from the Centers for Medicare and Medicaid Services, or CMS, released yesterday, found that 40 percent fewer insurers have applied to participate in the ObamaCare exchanges next year. The reason why that is important is because when fewer insurance companies choose to participate, of course, consumers have less choice and there is less competition in terms of quality of service or the price they charge. The damage goes far beyond the damage to the doctor-patient relationship and the damage to our pocketbooks, when we are told things will cost us less and they cost us more. The damage of the Affordable Care Act has literally permeated our entire economy and has led to a lot of people losing their jobs along the way. ObamaCare consists of a number of mandates, government coercion, and punishment if you didn't comply with the mandates that forced many Americans to buy a product they would not have bought of their own volition and in many instances simply could not afford. But if you refused to do it, the government fined you, punished you. That represents a radical change in the nature and guiding philosophy of this country. This country was founded on the concept of individual freedom, not on Big Government coercing you to buy something that you don't want and you can't afford. But that is the theory behind ObamaCare. In addition to that, for small business owners, it included a penalty for any business that exceeded more than 50 employees who did not provide government-approved health insurance policies. It cost them at least an additional $70,000 a year, in addition to other increases in healthcare costs. Let's say you are a small business of 50 or so employees. You are sure not going to hire over the cap and subject yourself to the additional $70,000 a year in costs. What you are likely to do is to hire fewer than 50 employees in order to protect yourself from that expense, and that is exactly what happened. I still remember, after the Affordable Care Act passed, having lunch in San Antonio, TX, with a friend of mine who was an architect at the particular time. When I described to him the nature of the employer mandate and its effect, he made it clear to me that he would rather lay off some of his employees in order to avoid that additional expense under the employer mandate. In fact, that is just what he did. This is just another bit of evidence about the pernicious impact of the Affordable Care Act. It is not just about premiums. It is not just about deductibles. It is not just about freedom of choice. Literally, it has been a wet blanket on our economy. This damage reaches across many different sorts of industries. According to a recent study by the Mercatus Center, an estimated 250,000 jobs nationwide were lost due to this mandate. That strikes me, frankly, as too small a number, but that is the number they projected. A quarter of a million people lost their jobs because of this mandate because small employers were motivated to keep their numbers under the cap in order to avoid the extra expense. This does not even take into account the consideration of businesses that were forced to shut their doors altogether. In other words, ObamaCare was, in part, premised on this idea that businesses could endlessly absorb additional taxes and new costs and mandates and somehow continue to keep their doors open and do business as usual, but that is not the real world. It also does not take into consideration the many businesses that choose to cut the hours their employees can work instead of firing them. This is another one of those stealth characteristics of ObamaCare, in which employers are judged on the number of full-time employees they have. I remember talking to a restaurant owner in East Texas--in Tyler, TX--who told me he had to lay off a single mother who was working as a waitress in his restaurant. He could not afford to have her work full time. He had to put her on part time in order to avoid the penalties that are associated with ObamaCare. What that meant for this single mom is that she essentially had to go out and get two jobs in order to fill the gap that was left by her going from full-time work to part-time work. That is not the only story I can tell you. A small business owner in Donna, TX, epitomizes this reality in a letter that was written to me a few weeks ago. This gentleman said he and his wife are both on Medicare. Of course, they are unaffected directly by ObamaCare because Medicare covers people who are 65 years and older while ObamaCare covers people who are younger than that. While they were left unaffected personally by ObamaCare's changes, on behalf of his 54 employees, he wrote that after ObamaCare went into effect, he was faced with a choice, either he could buy his employees expensive health insurance that his business could not afford or he could pay fines totaling more than $100,000. Instead, he made the painful choice to lay off six of his employees in order to remain under the ObamaCare-imposed threshold. As he pointed out, this meant more than just simply laying off six people; it also meant risking the well- being of each of those families represented by those six people. Small business owners should not be forced to choose between growing their businesses and providing jobs or risking the financial livelihoods of their entire companies and their employees just to satisfy the demands of Big Government. Even beyond causing layoffs, ObamaCare has effectively ensured that many businesses cannot grow and that existing businesses will not hire any more employees. ObamaCare did not just lead to a new form of healthcare coverage, as some have claimed, as two-thirds of the small businesses that were surveyed by the Mercatus Center report already offered insurance. Two- thirds of the businesses affected by ObamaCare already had healthcare coverage, but that was effectively displaced and replaced by government-approved healthcare, which proved to be far more expensive. Instead of having the choice to shop around for the insurance that best meets their needs and the needs of their employees, these businesses have been forced to either pay the penalty or to pay the piper--that is the Federal Government--when it comes to these mandates and these demands. It ought to be clear by now--7 years into the implementation of ObamaCare--that this kind of one-size-fits-all mandate should not be applied to a country of 320 million people, especially when it comes to something as personal as healthcare. Each of us is a unique human being. Each of our families has its own unique needs and desires. Frankly, we ought to be able to choose the sort of healthcare coverage that best suits our needs as well as our incomes and our desires to buy health insurance. Some people want policies that provide purely for catastrophic coverage when they go to the hospital. Maybe they prefer to have savings accounts that use pretax dollars under health savings accounts in order to save money so as to pay for their doctors' visits, and they combine that with a high deductible health insurance plan. You literally cannot do that under ObamaCare, but you will be able to do that under the Better Care Act, which we will be voting on next week. What we have tried to do is to look at the meltdown of ObamaCare and say that we need some emergency measures to take place because of the phenomenon I mentioned earlier in which insurance companies are pulling out, people's premiums are going through the roof, or deductibles are so high that they are effectively being denied the benefit of their health insurance. We need to do something quickly and urgently. What we are going to do is take measures to stabilize the insurance markets because if insurance companies continue to pull out of the insurance markets and deny people a choice or competition or even access to a qualifying policy at all, that is going to put people in an impossible situation. So the first thing we are going to do is to stabilize the marketplace. The second thing we are going to do is to repeal the mandates that have made health insurance so unaffordable and restore the freedom to choose the sorts of policies and create a marketplace in which people can choose the policies that best suit their needs and at prices they can afford. It will literally bring down the cost of what people are charged in order to buy healthcare coverage. Because we understand the importance of protecting families against preexisting condition exclusions, we are going to make sure the current law remains in effect that protects people from exclusions when they change jobs or lose jobs based upon preexisting conditions. The fourth thing we are going to do in the Better Care Act is put Medicaid on a sustainable growth rate. Medicaid is an important program. It provides the healthcare safety net for the Nation, but unfortunately it is unsustainable at the current rate of spending. Over the next 10 years, we propose to spend $71 billion more than we do today on Medicaid. In other words, it is going to continue to grow but at a more controlled and fiscally responsible rate. We are also going to provide people with tax credits who have an income between zero and 350 percent, including those people who are left out in the event that the Medicaid expansion is not embraced by their States and States like Texas--people who are now at 100 percent of the Federal poverty level up to 138 percent who were left out because of the fact that Texas did not expand Medicaid to able-bodied adults. They are going to be able to use that tax credit to buy private insurance. Private insurance provides much better access to coverage because, right now, Medicaid pays doctors and hospitals about 50 cents on the dollar when it reimburses them. Private insurance pays them much better so it improves the range of choices available to consumers. Our bill continues to be a work in progress. We have done our best to try to work with everybody who has been willing to work with us and to use their ideas. What we have tried to build is a consensus bill, but the fact is, our friends on the other side of the aisle have simply refused to participate in the process, thus leaving it up to us to save people and help people who are currently being hurt by the status quo. We are going to do our duty. We are going to fulfill our responsibility to our constituents the best we can under these circumstances. In recognizing that no bill is ever going to be perfect, certainly, we have to do what we can in order to help the people who are being hurt now under the status quo. Let me just close by saying that I have heard my friend the Senator from New York--the Democratic leader--talk about this bill. If we are unsuccessful in getting this bill passed next week, he wants to engage in a bipartisan negotiation in order to address healthcare. Yet what I predict is this: What he is really talking about is a massive, multibillion-dollar bailout of insurance companies without there being any reform. To me, that is an exercise that, frankly, I am not willing to participate in. I will never support a multibillion-dollar bailout of insurance companies and not be able to reform the system that created the problem in the first place. I urge all of our colleagues to work together with us. Bring us your best ideas. Work with us. Try to figure out a way to be constructive in this process and help us to achieve a result. It is not going to be the final result. We will have other opportunities, for example, in the Children's Health Insurance Program, which is a bipartisan program that expires by the end of September. We will have another opportunity to come back--hopefully, then on a bipartisan basis--to do additional things that we were unable to do because of the constraints of the budget reconciliation process and the fact that our Democratic colleagues simply refuse to participate in saving the people who are being hurt today by ObamaCare. I encourage my colleagues not to be lured by the seductive message of our friends across the aisle about doing something bipartisan after this bill is unsuccessful. They are not interested in changing anything about the structural defects in ObamaCare. If all we are going to do is propose to pay insurance companies billions of dollars more in order to bail them out--in order to support the same flawed structural program known as the Affordable Care Act--you can count me out. I suggest the absence of a quorum.

Mr. CORNYN

Mr. CORNYN. Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. CORNYN

Mr. CORNYN. Madam President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. CORNYN

Mr. CORNYN. Madam President, I know we are all glad to be back in Washington, DC, at work after a few days back home, and I know many of us are eager to continue our work to rescue the American people from the failures of the Affordable Care Act, otherwise known as ObamaCare. The failures of ObamaCare are well documented, and while they don't necessarily apply to everyone, particular individuals and small businesses in the so-called individual market have seen a meltdown of the insurance exchanges. The Presiding Officer in her home State of Iowa, I know, has had insurance companies pulling out to the point where people can't even find an insurance carrier who will sell a policy that qualifies under the Affordable Care Act. That is because the Affordable Care Act was, unfortunately, a partisan exercise and a Big Government experiment that has failed. All you have to do is look at the promises that were made at the time that ObamaCare was being sold back in 2009 and 2010. The President himself said that if you like your doctor, you can keep your doctor. Well, that proved to be not true. He said that if you liked your policy, you can keep your policy. Well, that proved not to be true as well because people saw their policies canceled because they couldn't qualify under the new requirements of the Affordable Care Act. Perhaps the thing that stung the most was the fact that the President said back in 2009 and 2010 that an average family of four would see a reduction in their health insurance premiums by an average of $2,500. Well, what we have seen since 2013 is a 105-percent increase in insurance premiums under the Affordable Care Act, and so instead of seeing a cut in their out-of-pocket costs of $2,500, what people have experienced--families of four--is an insurance premium increase of $3,000. Now, some people may be able to absorb that cost, but most people I know cannot. What it has meant is, they have had to reprioritize their spending so they have less to spend on other things in their life. We do know, based on the promises made at the time the Affordable Care Act was being sold to the American people, that it has been a failed experiment. So the question is, What are we going to do about it? What are we going to tell the folks in Iowa who can't find an insurance policy or an insurance company who is willing to sell them an insurance policy on the individual market? What are we going to tell people in Texas who have seen their premiums go up by 105 percent since 2013 and have been priced out of the market or who found that the only policy they can afford is one with deductibles that are so high that basically they are denied the benefit of their insurance at all? What are we going to do about it? A number of my colleagues have noted that even if Hillary Clinton were elected President of the United States, we would still have to be revisiting the failures of the Affordable Care Act because the failures are all too obvious and public and can't be denied, but despite that, and acknowledging many of ObamaCare's failings, many of our friends across the aisle--in fact, all of them so far in the Senate--have made clear they want nothing to do with providing any help or any aid to the people who are being hurt by the failures of ObamaCare. They don't want to lift a finger to help the people who can't find insurance, who can't afford it, and the policies they are forced to buy limit them in a way that they simply have decided to opt out. So instead of working together with us--you would think they would do that. It would just be a logical thing to do because their constituents are the ones who are being hurt, in many instances. Instead, they have fought us tooth and toenail to preserve the broken status quo in healthcare that has failed so many people across the country, and they have made dubious claims about our efforts to address the problem to the best of our ability. It reminds me of the old saying: Don't let the facts get in the way of a good story. Our friends across the aisle have simply washed their hands of any responsibility, even though they are the ones who passed the Affordable Care Act and created this failed experiment and put so many people in distress. Now they are in the process of attacking those of us who are trying to help people who are hurting, rather than lending a helping hand and working together with us in a bipartisan way. Let me talk just a minute about Medicaid because this is one of the big attacks that is being made by our Democratic colleagues on our efforts to try to salvage healthcare for people who are hurt by the failures of the Affordable Care Act. Much of the conversation has revolved around Medicaid and rightly so. In my home State, 4.7 million folks currently rely on Medicaid. It is an important safety net program for people who are in low-income status--so for poorer folks. For those Americans, I want to make sure they understand, notwithstanding all the scare tactics, Medicaid is not going away. Now, one of the common refrains is that Medicaid spending is slashed in the Better Care Act, but the nonpartisan Congressional Budget Office estimates that Medicaid spending will grow by $74 billion over 10 years. So when they have talked about it being cut, it actually grows by $71 billion over 4 years. I would also point out there are some who think the current rate of spending on Medicaid can go forward unabated without any changes, and that is simply not true. We know that according to the Congressional Research Service, Medicaid spending across the country totaled $494 billion in 2014. I guess that was the last year for which full statistics were available--$494 billion. If we do nothing to check the rate of growth of Medicaid spending, in 2023, it will be $835 billion. So you go from $494 billion to $835 billion. We simply cannot keep up with that pace of spending. Many of us--the Presiding Officer being one of them--are concerned about cuts in our military, which is the one thing the Federal Government has to do because nobody else can do it. Right now, we have seen, during the last administration, cuts of about 20 percent in our defense spending. Well, when you have runaway spending in entitlement programs like Medicaid, where nobody is placed on a budget and forced to spend wisely and efficiently, essentially by forcing the Federal Government to spend $835 billion for Medicaid spending alone, that is going to crowd out a lot of other meritorious and important spending, including for defense spending as well. So we need to make sure Medicaid is there but that Medicaid is put on a responsible budget that grows year after year. In fact, during the life of this particular bill, over the next 10 years, it will go up $71 billion. Here is another thing. Our friends across the aisle act like Medicaid is the very best program to come down the pike. Well, it is not, and there are a number of reasons for that. One is that Medicaid recipients don't always get the quality of care or the access to care we would hope for. That is because the States, which set the rate of reimbursement of doctors for Medicare beneficiaries, set it so low that it is roughly half the amount that is reimbursed based on private insurance. That is the reason why, in 2000, 67 percent of Texas physicians accepted new Medicaid patients. Today, it is 31 percent. So if you are on Medicaid, there is a two-thirds chance you will not be able to find a doctor to see you as a Medicaid beneficiary. What we have done, instead, in the Better Care Act--particularly for the single adult population between 100 percent and 135 percent of the Federal poverty level--is, we said we will give you a refundable tax credit you can use to buy private insurance. Private insurance is highly preferable to Medicaid because, for one thing, it reimburses physicians at a higher rate and gives people greater access to physicians, hospitals, and greater quality of care. In my State alone, in the State of Texas, according to the Kaiser Family Foundation, as many as 600,000 new low-income Texans will benefit from the provisions of the Better Care Act. It will help qualify them for a tax credit not available to them under ObamaCare. Simply throwing money at Medicaid will not help people at all. We need to reform Medicaid and make it more efficient. Frankly, one of the things I did back when we were debating the Affordable Care Act in the Senate Finance Committee, I actually filed an amendment that said Members of Congress would go on Medicaid. Well, it failed, but the point I was trying to make is that if Members of Congress were on Medicaid, we would fix Medicaid. Right now, it is substandard healthcare for the reasons I mentioned. Two-thirds of the doctors in my State alone refuse to see a new Medicaid patient because it pays them so far under the standard of private insurance or even Medicare. By providing low-income Americans access to private insurance instead of Medicaid, we can assist those who were previously left out of the healthcare market and will now be able to purchase a plan of their choice perhaps for the first time. Unless we act, we are going to continue to see skyrocketing premiums and deductibles and lost coverage. The American people were told time and time again that under ObamaCare costs would go down and they would be able to keep their doctor, which has proven not to be the case. I mentioned before on the floor of the Senate that in my previous life as attorney general of Texas, we had something called the Consumer Protection Division, and if some business made false claims about a service or product to the American people when it came to their healthcare, the U.S. Government would take them to court and we would win because it is simply a deceptive trade practice in that context. It is deception. It is deceit. Unfortunately, the American people were bamboozled by promises that were not kept. We also know that about $1 trillion in ObamaCare taxes--new taxes that were imposed to pay for ObamaCare--have ultimately been saddled on American families with higher costs for healthcare. When ObamaCare was passed and all these new taxes were passed, my friends across the aisle acted as though they would simply be absorbed by somebody, but we all know that simple economics means that ultimately the consumers are the people who actually pay the tab. They are the ones who end up paying the taxes. Some of our colleagues on the other side recognized the destructive nature of the Affordable Care Act tax scheme. For example, five Democratic Senators, including my colleagues from Minnesota, voted to repeal the medical device tax just 2 years ago. The medical device tax was a draconian form of taxation. It wasn't based on income--in other words, where you could deduct your expenses and just pay taxes on your net income--it was a gross receipts tax. In other words, it said in effect that everything you have earned before you deduct your costs of doing business is going to be taxed at a given rate, and that was true of the medical device tax. Perversely, a tax on medical devices meant not only did the jobs to produce those medical devices move offshore, in the case of one Texas- based company, they moved their business essentially to Costa Rica in order to avoid the taxes because they simply couldn't afford to pay them and stay in business and keep the jobs they had. It was also a tax on innovation, and that is the reason we saw a bipartisan response to repeal the medical device tax just 2 years ago, because this tax has chased away jobs and innovation in the medical sector and saddled consumers with higher costs. By repealing those taxes in the Better Care Act, we not only will lower the bill at the pharmacy or the doctor's office, but we encourage competition, and that is common sense and ultimately benefits consumers. Our plan also protects consumers from government mandates requiring them to buy insurance that they don't want and can't afford. This way, families can choose what works best for them, free from the penalties by the government. Some individuals may choose to go with no plan at all. The dirty little secret about the Affordable Care Act is that it can't work without a government mandate that you buy government- approved health insurance or else you pay a penalty. I can't think of any other instance where the government says ``You do what we say, or we are going to punish you and penalize you,'' as the Affordable Care Act does. Even with the individual mandate and this threat of a penalty, we know that about 28 million Americans are currently not covered by insurance. Many of them are covered by so-called hardship exceptions. About 6.5 million of them just pay the penalty because it is cheaper to pay the penalty than it is to buy the insurance because the prices are so high. When some of the critics say that without this economic gun to the head of a penalty, people will choose not to buy insurance for themselves, that is a choice they will make as Americans. We believe in freedom of choice, and when the marketplace provides a product that they believe adds value at a price they can afford, that is when consumers buy a product or a service. But they shouldn't have to do it because the government forces them to do so and penalizes them if they don't. The Better Care Act gives people the ability, free from a government mandate, to choose not to buy something they don't want. The Washington-forced mandates are gone. The nonpartisan budget office has estimated that under our plan, average premiums will decrease by nearly one-third in 3 years. These are some of the important facts we need to be debating, not the misrepresentations that unfortunately seem to fill the void. I have shared multiple stories from my constituents back home in the last few weeks on the floor, and I plan to keep doing that as we continue our work on this legislation. The stories that I and my colleagues have heard are what have inspired me and motivated me from the beginning of this entire process. In fact, it is our job to represent our constituents. I would encourage all of our colleagues to listen to their own States and to share the trials of their constituents as well because the status quo is simply unacceptable. The Democratic leader has said as much. He said that if we set aside the Better Care Act and are actually interested in helping ``fix'' ObamaCare, they are willing to do that. But do you know what that is? Basically, what that represents is a huge, multimillion-dollar bailout of insurance companies without any other reform. That is what our Democratic colleagues are supporting by their failure to engage with us in making sure there are reforms in addition to the other things that we do. The other alternative plan--you might ask: Well, if Obamacare didn't work as was advertised--which it clearly hasn't--and something needs to be done, what does that something look like? In the case of our friend the Senator from Vermont, Mr. Bernie Sanders, he said: I have an idea. Let's just make the Federal Government provide insurance coverage for everybody, single-payer. Well, that is simply a solution we can't afford when we look at the tradeoffs. It would essentially supplant all the private insurance that people get from their employers and require incredible increases in taxes in order to do that across the board. So I don't think that is an alternative our friends across the aisle want to support. They love the mandate, they love penalizing free American citizens when they don't purchase a product the government mandates, but they are not going to defend that. They are not going to defend that. They certainly won't advocate, at least openly here on the floor, for a single-payer system. We saw one committee of the legislature in California recently vote out a single-payer system. This was just one committee, I think, in one house. The estimated cost of a single-payer system in California alone was double the annual budget of the entire State. You can imagine what the numbers would be here at the national level. Like any piece of legislation, our draft bill can be strengthened, and we would invite anyone in good faith who is interested in strengthening the bill to work with us to do so. We are going to continue to talk and listen and exchange ideas on how we can continue to make improvements, but in the end, the choice is clear: You either ultimately support ObamaCare and the status quo, or you are willing to try to work with us to produce something better that provides more affordable healthcare from the doctor and healthcare provider of your choice. That is simply the choice people are going to have. A ``no'' vote against the alternative is simply a vote for the status quo for ObamaCare, and we know where that is going to lead--it is going to lead with a big, multibillion-dollar bailout of insurance companies without any reform. That is what our Democratic colleagues are hoping for if we are unsuccessful. But we think there is a better way to approach this, one that brings down cost and maintains choices and the freedom of choice for the individual consumer. We will continue to plow ahead with or without their help because we think it is our duty to do so, and we have confidence that, working together, we can come up with a better care plan that suits the needs of Americans when it comes to their healthcare. I yield the floor. I suggest the absence of a quorum.

Mr. CORNYN. The following Senators are necessarily absent: the Senator from Alaska (Ms. Murkowski), the Senator from Ohio (Mr. Portman), the Senator from Alaska (Mr. Sullivan), and the Senator from North Carolina (Mr. Tillis). Further, if present and voting, the Senator from North Carolina (Mr. Tillis) would have voted ``yea'' and the Senator from Alaska (Ms. Murkowski) would have voted ``yea.''

Mr. CORNYN

Mr. CORNYN. The following Senators are necessarily absent: the Senator from Alaska (Ms. Murkowski), the Senator from Ohio (Mr. Portman), and the Senator from Alaska (Mr. Sullivan). Further, if present and voting, the Senator from Alaska (Ms. Murkowski) would have voted ``yea.''

Mr. CORNYN

Mr. CORNYN. Mr. President, I want to come to the floor to talk about healthcare, a subject I know the Presiding Officer feels passionate about as a medical doctor. But before I delve into the healthcare debate, I want to discuss briefly two important bipartisan pieces of legislation that I have been working on with my colleagues across the aisle and that are moving forward today. I know the strange thing about this place--by ``this place'' I mean Washington, DC--is that the bipartisan work we are able to do rarely gets much attention. What gets attention in the news is when we fight over controversial topics, but bipartisan legislation that actually helps people and that gets done here is rarely heralded or even noticed. So I think it is worth highlighting a couple of examples today. Today, in the Senate Judiciary Committee, we passed the Abolish Human Trafficking Act, which I introduced with Senator Klobuchar. As the father of two daughters, I am always reminded of the profile of a victim of human trafficking in this country, a girl between the ages of 12 and 14 years old, who perhaps has run away from home. Who knows what the circumstances are at home? But they are looking for a better life, only to find themselves in too many instances exploited and the victims of human trafficking. This bill reauthorizes several critical trafficking victims protection act programs that help fight the scourge of trafficking so that survivors can get the help they need and our law enforcement officers can go after the perpetrators of this terrible crime. A vital provision of this bill is an extension of the Domestic Trafficking Victims Fund, which provides critical resources that victims need to recover from this crime. Part of the fund is financed through fines collected on convicted traffickers, and last year it provided almost $5 million in services for victims. Let me dwell on that for just a minute. When I was privileged to be attorney general of the State of Texas, part of the job was to administer the Crime Victims' Compensation Fund. This was a fund into which fines and penalties of people convicted of criminal acts went into the Crime Victims' Compensation Fund, so we could then use grants for the victims of crime to help them recover. That is exactly the kind of model we created with the Domestic Trafficking Victims Fund. My hope is that over time it will produce more money that will be available to help the victims of human trafficking to a greater extent. That is the idea, and these are not tax dollars, so that is an additional benefit. It is actually the fines and penalties of the perpetrators that go into this fund that then help the victims to heal. This bill also makes the Human Trafficking Advisory Council permanent so that the group of survivors who advise people like us on what additional tools are needed to combat trafficking can continue to do so. On the preventive end, this legislation lends a hand to our Nation's law enforcement so they can track down perpetrators of the crime and bring them to justice. It implements screening protocols for the Department of Homeland Security so that law enforcement officials at every level know how to spot trafficking victims and how to respond. This is actually a really important element of fighting human trafficking. A few years ago, when we had the Super Bowl in Dallas, TX, I was shocked to learn that the Super Bowl is one of the largest human trafficking events during the year. That is pretty sobering and, frankly, disgusting. Training people, including law enforcement, to be able to identify victims of human trafficking, some of whom may not consider themselves a victim until it is too late, only to find themselves a victim of modern day human slavery--but being able to identify victims of trafficking so that we can get law enforcement involved and get them rescued is a big, important part of fighting this crime. In the long run, this legislation requires the Department of Justice to implement a national strategy to reduce the demand of human trafficking by essentially putting the johns--the people who buy sex from trafficking victims--out of service. This is a cause that clearly crosses partisan lines, and it is literally a nonpartisan issue. I am glad we are making progress on this. I am thankful for the bipartisan support of my colleague from Minnesota, Senator Klobuchar, as well as the Judiciary Committee members like the chairman, Senator Grassley, and the ranking member, Senator Feinstein, and many other Members on both sides who are cosponsors.

Mr. CORNYN

Mr. CORNYN. Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. CORNYN

Mr. CORNYN. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. CORNYN

Mr. CORNYN. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. CORNYN

Mr. CORNYN. The following Senators are necessarily absent: the Senator from Arizona (Mr. Flake), the Senator from Georgia (Mr. Isakson), and the Senator from Alabama (Mr. Strange).

Mr. CORNYN

Mr. CORNYN. Mr. President, will the Democratic leader yield for a question?