Bill Cassidy

Mr. CASSIDY

Mr. CASSIDY. Mr. President, I thank the Senator from Colorado for his kind words. I rise to speak about our Republican effort to repeal and replace the Affordable Care Act. I always kind of chuckle when I say the ``Affordable Care Act,'' as I have a friend back home whose quote for his insurance was $39,000 for 1 year. That is the un-Affordable Care Act. A family member from San Francisco whose policy was $20,000 for 1 year had a $6,000 deductible for each person. I think her husband actually voted for Bernie Sanders, but she is like: The heck with this because I cannot afford it. Then there is another fellow here in Washington, DC, who is an insurance consultant. If anybody can get a good deal, an insurance consultant should be able to. He says: My family premium is $24,000 a year with a family deductible of $13,000. We will pay $37,000 before we receive benefit from our insurance policy. That is unsustainable. President Trump saw that during the campaign. He said over and over again--kind of his four pledges, if you will--that he wished to maintain coverage, lower premiums, get rid of those mandates that Americans hate in ObamaCare, and care for those with preexisting conditions. This is what he said over and over. It is a great pledge. He actually said something else as well: He said he wanted to make healthcare easy. Now we have an approach to do this. Some people call it auto enrollment, but I call it making it easy. In this way, we can increase coverage and achieve the goals of President Trump's to lower the premiums. We are using something that is already used in Medicare and 401(k) plans. Again, we make it easy to enroll. Let me elaborate on this. People argue that we have to have a mandate because without a mandate, people will lose coverage, and if people lose coverage, only the sick enroll and healthcare expenses increase. I think the Senate actually has an opportunity to do something better. We can make it easy. Under this, we can imagine that someone is eligible to be enrolled in our program unless he calls us up and says he does not want to be. This is what we do in Medicare. When we--when I, when you, when any of us--turn 65, we are automatically enrolled in Medicare. I turned 65, and I am on Medicare. It is not a mandate. I can call them up and say that I do not want to. You have never heard anybody complain about it. It is just called making it easy. Similarly, when a Fortune 500 company puts in a 401(k) plan, it has learned that if it asks somebody to sign all of the forms, and they can opt into its 401(k) retirement plan, it gets about 65 percent participation, but if they say: You are in unless you call us up and tell us you do not want to be--if they make it totally easy, they get 95 percent participation in that 401(k) program. We know both from Medicare and from business that if you make enrollment easy, you have 95 percent participation. Now, that is so good in the setting of this because if we have all of those enrolled who are eligible to join the ObamaCare replace plan, we make that insurance pool large. We call it a pool for a reason. If you pour a cup of water into an ocean, it does nothing to the level of the ocean. Similarly, if you have one person who is ill who is in a big pool of otherwise healthy people, it does nothing to the expense because the expense of that one person's illness is spread over many. So by making enrollment easy-- fulfilling President Trump's pledge--just like the ocean with one cup of water, that one person who is sick, the expense spread out over many, the impact on any one person's premium is nil. By the way, there is a lot of conservative support for this sort of concept. First let me just say that coverage is important. If we pretend that people having coverage is not important, it is just not true. I am a physician. I can tell my colleagues there are many conversations I have had where someone who was poorly insured or uninsured might need some critical medicine or critical procedure and we had to work, scramble, do everything we could to get her the coverage she needed to have sometimes a lifesaving procedure. Rich Lowry is a conservative columnist for the National Review. He had a column saying that the worst argument against replacing the Affordable Care Act is that coverage is not important. Coverage is important. If we go on toward this kind of concept--make healthcare enrollment easy; you are in unless you are out--Jim Capretta, Joe Antos, and Stuart Butler have all spoken about using this concept. Nina Owcharenko and Bob Moffit of the Heritage Foundation wrote in Senator John McCain's Presidential plan in 2008 that it would be accompanied by a system of automatic enrollment of health insurance, either at the workplace--and then they go on. But they were praising the Presidential candidate's--but now Senator John McCain's--employment of let's make it easy to enroll. By the way, President Trump kind of emphasized this. Just before he was inaugurated on January 15, he gave an interview to the Washington Post and he was talking about his proposed healthcare law. We have already mentioned the components that he said were in it. He wanted all covered, caring for those with preexisting conditions, getting rid of the mandates, and lowering premiums, but he added this: People under his law ``can expect to have great healthcare. It will be in a much more simplified form. Much less expensive, and much better.'' I like that: simplified. Under ObamaCare, we have like 16 pages online that people have to fill out with all their W-2s with them in order to find out if they are eligible. The patients I saw in a hospital for the uninsured where median income may have been $16,000, people lived in perhaps public housing, they took public transportation to the public library in order to log on because they did not have a home computer, much less internet. That is not simple. That is why enrollment numbers are lower for lower incomes. We make it easy. Let me just emphasize one more time: If we can get that bigger pool of people, premiums fall. So for my family member in San Francisco who can't afford that premium, if we get that pool bigger, premiums fall. Similarly for the insurance consultant here or my friends back home in Louisiana, if we can make that pool bigger by making enrollment easier, their premiums will fall. I will just say that I call myself a kitchen table conservative. All those conservative families who voted for Donald Trump, who sit down at their kitchen table and they know they can't afford a $20,000 premium and already they are struggling with their car note, their house note; they have given up sending their kids to a private school; they are doing whatever they can to make ends meet. Under the un-Affordable Care Act, they are required to pay so much. When they heard President Trump say that he would lower their premiums, they saw that as a lifeline for their family budget. Their vote for President Trump was a cry for help: Help us with insurance premiums we cannot afford. Now, as a kitchen table conservative myself, to those families who voted for Republican candidates over the last several elections but who absolutely know they need help with their health insurance, we have a solution for them. But let me pause for a second. You don't have to be a conservative to care for this solution. In fact, people on the left have actually endorsed this concept as well. I will end by saying this. As we come up with a replacement plan for the Affordable Care Act, it will not be a Republican solution and it will not be a Democratic solution. At its best, it will be an American solution--an American solution for that family at the kitchen table, struggling to pay their premiums, who can't do so now but know that they need coverage. In so doing, if we can fulfill President Trump's campaign pledges to cover all, caring for those with preexisting conditions, eliminating mandates, and lowering premiums by making enrollment easy through something called auto enrollment, we will have done our job. Mr. President, I yield the floor.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, obviously, a big problem before the country right now is, What do we do about rising healthcare premiums? What we know under the Affordable Care Act--or the un-Affordable Care Act--or ObamaCare, as some call it, is that premiums are rising more and more. One of President Trump's campaign pledges was that premiums would come down and, actually, come down with, as he said in one place, beautiful coverage--that it is actually good coverage and premiums are lower. So let's kind of set the stage. I just got a message on my Facebook page. I will read it. By the way, anybody can post on our Facebook page these sorts of stories, if they are interested in them. Brian from Louisiana sent a message saying: My family plan is $1700 a month for me, my wife, and two children--so roughly about $20,000 a year. The ACA, or the Affordable Care Act, has brought me to my knees. I hope you can get something done as my credit cards are all maxed out. And 80 percent of my friends are in the same situation. The middle class is dwindling away. Can everyone just come together and figure this out? Think about this: $1,700 a month. He did not write this, but what would be standard for this sort of policy is a $13,000 family deductible. I say that because I have an acquaintance in San Francisco. San Francisco is so expensive for housing, transportation, and food, and the premium for their young family is $20,000 a year, with each family member with their own separate $6,000 deductible. This is under the un- Affordable Care Act, as I call it, or the Affordable Care Act, as others do. A friend of mine back in Baton Rouge, whom I have quoted many times, put this on my Facebook page because people would not believe it: He and his wife, 60 and 61, their quote for their insurance last year was $39,000. Their quote for their insurance was $39,000. Then I spoke to a fellow who is an insurance consultant here in Washington, DC--an insurance consultant. If anyone can get their premiums down, it would be he. For his family, their premium is $24,000 a year with a $13,000 family deductible. If they get in a car wreck, their family will be out $37,000 before the insurance kicks in. Who can afford this? We must do something better. When President Trump ran for office, President Trump clearly recognized this. On the campaign trail, he said over and over that he wished to lower premiums. It is the President's genius, if you will, that he knew how to do so. You do so by expanding the risk pool. He said he wanted to continue coverage for all. He gets away from the ObamaCare mandates, which people hate. The American people don't like being told what to do. He also said he would care for those with preexisting conditions. This is how it works. When you cover many, you have a bigger risk pool. Those with preexisting conditions have the cost of their illness spread out over the many. So premiums come down for all. My hat is off to the President for coming up with that. In fact, 5 days before he was sworn in, he echoed this, because one way to lower premiums is to give poor coverage. One way to lower premiums is to give folks such terrible coverage that it doesn't cost anything. On the other hand, it doesn't cover anything. The President seems to know this. Five days before he was inaugurated, he said to the Washington Post about people covered under his replacement for ObamaCare: [They] can expect to have great healthcare. It will be in a much simplified form. Much less expensive and much better. We're going to have insurance for everybody. There was a philosophy in some circles that if you can't pay for it, you don't get it. That's not going to happen with us. I am a physician, a doctor. Again, I admire President Trump's insights. As a physician, I know that whoever wants healthcare gets healthcare. Twenty or so years ago, Congress said that if you walk into an emergency room, the emergency room has to take care of you. It doesn't matter if you are an American citizen. It doesn't matter how much it costs. The hospital has to take care of you. I told folks when I was practicing--it would be the middle of the night--that as long as that emergency room was open--and it was open 24/7--in through the door came folks vomiting blood, heart failure patients, folks with drug overdoses, schizophrenics, diabetics, asthmatics--you name it. They came through that door, and we cared for them all--and somebody paid. President Trump understands that even if you say you can't afford it, everybody is going to be treated. That is our current system, and that is not going to happen under his watch. We mentioned that one way to lower premiums is to give poor coverage. I think everyone knows, or many people know, of Mr. Kimmel, the late night comedian who pointed out that when his child was born, instead of celebrating and handing the baby to the mother so the mother could kiss and the father, Mr. Kimmel, could cuddle the baby, the nurses and the doctors looked at the baby and immediately recognized that something was wrong. They recognized that this child was blue. He didn't have oxygen, and if something wasn't done immediately, this child would die. Folks criticized Mr. Kimmel for being emotional. I totally get it. Instead of cuddling, you are signing a release waiver so your child can be transferred across the city of Los Angeles for emergency surgery. In his emotion, he asked that all children--and I would expand to all Americans--have the ability to get that sort of emergency care done. Again, the President was about that. I came up with what I called the Kimmel test. Again, it echoes President Trump's contract with the American voter--that we would protect those with preexisting conditions, that we lower premiums, but as we lower premiums, we make sure that the coverage is adequate. The Kimmel test, making sure there is adequate coverage while lowering premiums and caring for those with preexisting conditions, is so compatible with what President Trump said, because Americans need lower premiums. Let me echo that one more time. We need to lower premiums. The President's approach, the contract he made with the voters on the campaign trail, is the right approach. You get a bigger risk pool, lots of younger people, so those who are older and sicker have the cost of their care spread out among the many. We have a plan, the Cassidy-Collins plan, or the Patient Freedom Act, which I introduced with Senator Susan Collins and four other Senators. We have a way to go about it. One way to get young, healthy folks involved is to do something that we do on Medicare. If you are eligible, you are enrolled unless you call up and say you don't want to be. That is what we do with Medicare. By the way, that is what Fortune 500 companies do with their employees for 401(k) plans, and it works really well. Ninety-five percent of employees are likely to participate in a 401(k), and they love it. As to people on Medicare, 99 percent stay on Medicare, and 1 percent call up and say: I don't want it. Usually they have better coverage someplace else. As a rule, no one feels coerced because they all know they can call up and say: I don't want it; I don't get it. As it turns out, most do. The plan we have taken with Cassidy-Collins, in our attempt to fulfill President Trump's contract with the American voter, is that we allow a State to automatically enroll for this, and you would be in. The credit you receive would be sufficient to pay for the annual premium. If you don't want it, call up. Make it easy. Get out of here. I don't want it. As a rule, we think folks would be in. By doing this, you expand that risk pool so those old and sicker, those with preexisting conditions, can have their conditions cared for, but we fulfill President Trump's campaign pledge. We also lowered those premiums. Ultimately, to lower the cost of insurance, you have to lower the cost of healthcare. Cassidy-Collins does that with some conservative approaches that even liberals will like. One way is that we put in what is called price transparency. You would know the price. A mother would know the price of a procedure--an x-ray, a blood test--before she gets it for her daughter, as opposed to finding out 6 months later when she gets the final bill. Let me give one example. We have all seen those urgent care centers. Some are run by hospitals. Typically, a visit there will cost you $500 to $1,500. Others are run by a group of physicians, or maybe a small business decides to set up an urgent care center. The same visit might cost you as little as $75 to $150. The patient doesn't know that until she gets the bill. One door has exactly the same appearance and exactly the same type of facility with the same capabilities. In one door and it can cost $500 to $1,500, and in the other door and it can cost $75 to $150, and the patient never knows. I think we can lower the cost of healthcare by giving the patient the power of knowing what is the price of healthcare. Think of it. You walk up to a French restaurant in a city you are not familiar with, and you look at the menu posted on the door. You see the prices of the food. Oh, the food is pretty good, but look how expensive it is. Let me go down the street. You go down the street. The food looks good, and it is less expensive. The power of price informs the patient of what is the best deal for both our health and for our pocketbook. One way we can lower the cost of health insurance is by lowering the cost of healthcare. There are other ways of doing so as well. Let me return once more to what I said earlier. Americans need lower premiums. President Trump, during the campaign--his contract with the voter, I think, is the right approach to get there. I will summarize with this. He said he wanted to maintain coverage for those who have insurance, lower premiums, that preexisting conditions would be cared for, and eliminate the ObamaCare mandates. If we fulfill President Trump's goals--and these are goals that folks on the right and left can get behind. By the way, if we do get behind them, premiums will be lower. If we can fulfill President Trump's campaign contract with the American voter, we will lower those premiums, and we will do so by achieving these other great goals. I yield back. I suggest the absence of a quorum.

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

Mr. CASSIDY

Mr. CASSIDY. Mr. President, I suggest the absence of a quorum.

Mr. CASSIDY. Mr. President, it is fair to say that Americans are sick of partisanship when it comes to issues of greatest concern. They are asking, if you will, that we in the Senate put party behind us--behind the needs of the people. This is especially true when we are speaking of those issues of greatest importance, and I would argue that the replacement of the Affordable Care Act is one of those issues of greatest importance. Whatever the excuse, no Senator of either party should sit on the sidelines. This is such an important issue that every Senator, whatever her or his personal views, should be engaged. We know President Trump's principles, if you will. He laid them out time and again on the campaign trail. He wants to maintain coverage, lower premiums, care for those with preexisting conditions, and eliminate the ObamaCare mandates upon individuals and businesses. At his inauguration speech, he spoke of the forgotten man and of the forgotten woman. In fact, we can see that just before his inauguration, he emphasized that with what he said during the campaign: We're going to have insurance for everyone. There's a philosophy in some circles that if you can't pay for it, you don't get it. That is not going to happen to us. He also emphasized the quality of the care, saying that people covered under the law that he would propose to replace can expect to have great healthcare. ``It will be in a much simplified form. Much less expensive, much better,'' he said to the Washington Post just before he was sworn in. These are his principles. When he was sworn in and gave his inaugural address, speaking of the forgotten man and the forgotten woman, I cannot help but think that he was influenced as he went through counties seeing folks with terrible tales of their child dying from opioid addiction or their spouse unable to afford insurance under ObamaCare. I will point out that there is a huge dimension to this that we sometimes forget, but we should not. Senator Jerry Moran from Kansas made the point that healthcare is like no other issue. It is an issue which touches us most personally. I think President Trump saw that on the campaign trail. He saw the parent of an adult child with mental illness, and she could not get a psychiatric bed for her child. We know the fate of that child if he does not have the care he needs. He will end up either in a homeless shelter, a jail cell, or the morgue. That is the human dimension to this, and that is why we need to help President Trump fulfill his pledge. Voters understand what we are speaking of; they understand the importance of it. But let me speak just a little bit more to the politics of this because we cannot separate what we do here in Washington, DC, from politics. There are researchers from Princeton who recently published a report. If you look at White males and females between 18 and 54 who lack a college education, their life span is decreasing. Now, for Hispanics, African Americans, and other minorities, it is improving, but for this group, it is decreasing. I have seen data which shows that in the population centers of the United States in which this phenomenon is being most seen--these Whites from age 18 to 54, noncollege educated, their life span is decreasing-- the counties in which this effect is most seen were most likely to vote for Donald Trump. Think about the politics of this. The politics are that a group of folks who understand that their life is materially and physically declining, with higher rates of suicide, addiction, liver disease, and other chronic illness, ending in premature death, voted significantly more for the President who swore that he would remember them, who spoke of the forgotten man and the forgotten woman. His pledge to them was a lifeline. Their vote for him was a cry for help. This is not just a human dimension; there is a political dimension leading to a policy necessity. Let's stop for a second. There is a key issue of cost. We understand that the Affordable Care Act was too expensive. We can save money. But let's not fool ourselves; it is still going to cost. We can save the $150 billion or so that the House suggested we have to save. We know the rules the Senate has to address to save at least that much money. On the other hand, we know that Congress has mandated people can get care; therefore, if Congress mandates that folks get care, then Congress should help provide the means by which to pay for it. There are some who think, oh, my gosh, Congress does not need to provide for the money for care, and everything will be good. I am a physician. I have been in the emergency room at 2 in the morning, and at 2 in the morning, when those emergency room doors are open, whoever comes in is treated. She may have heart failure, he may have a drug overdose, they might be a schizophrenic, or they might be somebody vomiting blood. Each one of them receives all the care that he or she needs to stabilize their emergency condition. And if they have to be hospitalized--think of a car wreck with multiple traumas--and they are in the hospital for 4 months, they still get that care because Congress mandates that. But, if Congress does not provide the means to pay for it, the cost of that care is shifted not to government; the cost of that care is shifted to the privately insured. All of those getting their insurance through their employer begin to pay higher premiums-- much higher premiums. Somebody pays. And if we do not fulfill our obligation, after mandating that those patients get cared for--we, being Congress--then society pays, and society is the person struggling to make ends meet and now finds out from her employer that her premium has increased 20, 30, sometimes 50 percent--all because of the cost- shifting that occurs. It is not just the group market. Under ObamaCare, we can see that in the individual market, premiums have skyrocketed. It is not that the Affordable Care Act is working so well. Last week I communicated with someone who lives in San Francisco, and she and her young family are paying $20,000 a year for a premium, $6,000 deductibles; none of them is sick, none of them will meet their deductibles, but living in a very expensive city, having to struggle to pay their mortgage, groceries, and transportation, now they have to come up with $20,000 to pay for their healthcare. That is all because of the Affordable Care Act. Then I spoke with a person in Washington, DC, and someone in Washington DC--that person who is a consultant on insurance issues, knows insurance backward and forward, says that for his family, the premium is $24,000 a year, with a $13,000 family deductible. The insurance expert says: I will be out $37,000 in a single year before my insurance kicks in. Families cannot afford that. I will finish up lastly with a story from Louisiana. Folks never believe this because it seems too crazy, but I put it on my Facebook page. There is a couple back home, 60 and 61. They were quoted a premium of $39,000 for a premium of one year, with a deductible on top of that--$39,000. We can see that in the individual market, the Affordable Care Act is not working, it is becoming the un-Affordable Care Act. We have to address this. But let me say, we have to address it whether we are a Democrat or a Republican. We must respond to the cries for help coming from those folks suffering from addiction, mental illness, heart failure, or any other chronic disease for which they do not have coverage, but also to the cries for help from middle-class families who cannot afford these premiums, and if they don't sacrifice something in the budget to pay for it, under the Affordable Care Act, they will be fined. Let's return to the political side. The political side is that I have voters back home asking why Republican Senators are not helping a Republican President fulfill his pledge--a pledge to all voters--but one that certain Republican voters specifically took to heart; that is, to fulfill his pledge of caring for those with preexisting conditions, continuing coverage, lowering premiums, and eliminating mandates. If you are a Democratic Senator, the forgotten woman and the forgotten man is in your State too. I can promise you, even if you are not a Republican but you are a Democrat, you have an opioid crisis in your State. So if we are now looking at addressing Medicaid expansion or the affordability of the individual market, and you are a Democratic Senator and you decide to sit on the sideline--if you are a voter in that State, you should be asking why. Let's face it. Speaking of my Democratic colleagues, many of you do not like President Trump. Some of you hate President Trump. Some of you like him, but you have to pretend that you hate him. Even though this is President Trump's pledge, this is not about President Trump. This about the voters--the patients, the people in our States who either cannot afford their insurance or who have an addiction or some mental illness or some other critical mental healthcare need that, if this ObamaCare replacement is not done well, will leave them far worse off. I have heard some of the excuses from my Democratic colleagues as to why they cannot participate. They say: Oh, we are using the word ``repeal'' or, oh, we are not going through a normal committee process--oh, this, or oh, that. I concede it all. Who cares? If you are a voter right now, and your child is addicted to opioids, do you really care that there is a semantic issue regarding whether or not we are saying ``repeal'' or ``repair''? Do you really care that after 8 years of hearings, we don't have a few more hearings? Do you even understand the difference between reconciliation versus normal process? I would say no, because the principal thing that concerns you is that your child is desperate for help and you are not sure that the help will continue. So I say to my Democratic colleagues: Whatever the excuse, ignore the excuse, and please engage. Let me finish where I started. I think the average American right now wants every Senator, whether Republican or Democrat, to help President Trump fulfill his pledge to maintain coverage, lower premiums, and care for those with preexisting conditions, without mandates. Every Senator should listen to the American people as they ask us to put patients over party, to put the American people over partisanship. Mr. President, I ask unanimous consent that the time during quorum calls until 12:30 p.m. today be equally divided.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, before us as the Senate right now, aside from issues Mr. Blumenthal referred to, is the repeal and replacement of the Affordable Care Act. I am a physician, and I have been practicing in hospitals for the uninsured for the last 25 years. I would like to in one sense say that gives me special standing to speak about this issue, but in reality, it does not. Senator Moran from Kansas spoke up the other day at our lunch. He said that healthcare is like no other issue. He spoke of a friend of his approaching him at church with tears rolling down her face. Her mother had a preexisting condition, and she was so concerned that we get this right. I don't need to say I have special standing, being a physician. We all have special standing from living, having families and friends who--sooner or later, healthcare will affect the family. The Affordable Care Act for many is not working. Premiums are going sky high. Two or 3 days ago, I had communication with someone from San Francisco. Her young family has a $20,000-a-year premium, a $6,000 deductible for each member of the family--in San Francisco, already paying so much for housing, food, and transportation, and $20,000 on top of that for a family of relatively modest income. Then I spoke to someone in Washington, DC. His family's premium is $24,000; they have a $13,000 deductible. He said: I am out $37,000 before my insurance kicks in. I reassured him that his colonoscopy would be for free. I don't think he thought that funny. Then a friend of mine who last year in Louisiana--his quote for a policy for himself and his wife, 60 and 61, was $39,000 for 1 year-- $39,000 for 1 year--with a deductible. Now we are being told there will be premium increases this coming year. In Connecticut, they just announced they are going to be 15 to 35 percent higher. In my own State, I have been told they may approach 30 to 40 percent higher, although that is not definite. The reality is that premiums have become unaffordable. President Trump campaigned on this. There were four things he told the American people. He said he wanted to cover all, care for those with preexisting conditions, eliminate the Affordable Care Act mandates that people hate so much, and lower premiums. I would like to say I think it is part of President Trump's intuitive genius. Whatever you say about the fellow, he certainly has an intuition sometimes about how things work. Of course, the way you would lower premiums is that you would cover all, and by covering all, you expand the risk pool, which then lowers premiums for those with preexisting conditions but keeps them lower for the rest of us. Folks ask how you can do that without mandates, and I say you can do it through the mechanism of the Cassidy-Collins plan, the Patient Freedom Act, which is to say you have an auto-enrollment feature. By the way, here is President Trump. He said it many times, but here he is in the Washington Post on January 15, 2017, just before he takes the oath of office: ``We're going to have insurance for everybody,'' Trump said. ``There was a philosophy in some circles that if you can't pay for it, you don't get it. That's not going to happen with us.'' You cannot have a stronger statement from a fellow who is about to rise to be inaugurated and gives a speech in which he speaks passionately about the forgotten man and the forgotten woman. President Trump pledged to remember them. The question is, How do you lower premiums? How do you fulfill President Trump's goals? There are several ways to lower premiums. I just described one, where you fulfill the other parts of his contract with the voter, which is you cover all, and by doing so, you increase the size of the risk pool, and therefore you lower premiums. There is another mechanism. You can put in price transparency and do other things to lower the cost of medical care, which in turn lowers the cost of healthcare premiums. But there is one way which is not so good. One way that you can lower cost is to have a crummy policy that hardly covers anything. You think you are getting a deal in the front end because premiums are low, and then you or someone in your family gets sick, and it is not such a great deal after all. I was asked about this on a Sunday morning show and spontaneously came up with something called the Kimmel test. Jimmy Kimmel, the late- night comedian, spoke of his son being born. We can all imagine--this happened 2 weeks ago--his child was born. I suspect somebody is videoing it. It is going to be a moment of celebration. As the child emerges and everybody wants to lean forward and hand the child to the mother and the father to hold and cuddle, instead, the doctor and the nurse notice that the child is blue--``blue'' meaning he is not getting enough oxygen. It is quickly realized that something is profoundly wrong. Instead of mother and father hugging and bonding with the child, they are pushed to the side. They hear a code blue call, which means this child will die if something is not done immediately. I was not there, but I have been in similar situations. They are being asked to sign forms which would allow this child-- their child whom they have not yet held--to be transported by helicopter across Los Angeles to have emergency surgery that day and being told that if they do not sign this form, that child will die. Now, Jimmy Kimmel pointed out that he is a millionaire, he could afford it, but he also pointed out: Others, not so much. I think that brings us back to what President Trump said. President Trump said: ``We're going to have insurance for everybody. There was a philosophy in some circles that if you can't pay for it, you don't get it. That's not going to happen with us.'' The Jimmy Kimmel test: We will protect those with preexisting conditions, but we will do it by lowering premiums and not by giving crummy coverage but, rather, by having adequate coverage. So if our approach passes the Kimmel test, then we feel it is a way to go. Now, how do we go from here? We can recognize that premiums are too high for middle-class families. They can no longer afford it, and that is before the premium increases, which are about to occur. I will also say that as to the way the Affordable Care Act was passed--not blaming or praising anyone--that only one party was engaged is not the path forward. History says that any time there is significant social legislation that has an enduring effect in the United States, both parties engage. I want this to change. I would challenge my Democratic colleagues to become engaged. Some have said: Oh, my gosh, Republicans are doing this through reconciliation; isn't that terrible? I would say it presents opportunity. We don't need 12 Democrats; we don't need 8 Democrats. We could have three Democrats or four Democrats. Anyone who cares enough about the people in their State and their premiums, which are rising 20 to 40 percent a year, will put aside all the pressure from a political base and say: The people of my State are more important than the political pressure I may feel. They will step forward to influence the final product. We know that if folks come in from the other side of the aisle, we will have a different product than if it is only among Republicans. If Republicans had participated in the passage of the Affordable Care Act, we would have had something perhaps a little different than the Affordable Care Act. I am not pointing fingers. I am just observing that it would only take three or four Democrats to break ranks, to step across the aisle, and to ask for what they would need. This is not: You come to us, and you don't get it--no. We have a meeting of the minds so that we can come to the policy that fulfills President Trump's pledge--his pledge to cover all, caring for those with preexisting conditions, eliminating mandates, and lowering premiums. We have an incredible opportunity before us to bring relief to those middle-class couples struggling with premiums that they can no longer afford and deductibles that they will never meet. If they don't meet and can't afford them and if they do not purchase the insurance, they are being fined and are accumulating resentment toward Washington because they are stuck with this. We can address that issue and at the same time fulfill President Trump's pledge that all will have coverage. Some said you can't get it if you can't pay, but that is not going to be the case with us. It will provide them that coverage with something that passes the Kimmel test. I look forward to working with our Senate to come to this solution. I yield back.

Mr. CASSIDY

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

Mr. CASSIDY

Mr. CASSIDY. Mr. President, the topic before us is clearly the repeal and replacement of the Affordable Care Act, and that is what I rise to speak about today. In part I will speak as a Senator, and in part I will speak as a doctor, as I am a physician. My wife is also a physician. I worked in a hospital for the uninsured for many years. First, let's just describe the state of play. It is so interesting, President Obama's healthcare law, the Affordable Care Act, ObamaCare. I had two different communications yesterday, one from a sister-in- law in San Francisco. I think her husband voted for Bernie Sanders. She is, you know--but she said: This is incredible. Speaking of herself, she said: I am paying $20,000 a year in premiums, and each of my family members has a $6,000 deductible. They have to pay San Francisco prices for everything, and they make good money but not exorbitant money. They are paying $20,000 a year for a premium, for a young couple in good health, with a family deductible probably of $13,000. The next communication was in a phone call with a consultant here in Washington, DC, who does healthcare. He knows his stuff, and at some point, he breaks out of sort of a professional kind of ``this is the way I talk,'' and he says: You don't see my insurance. I am paying $24,000 a year for premiums, and I have a $13,000 family deductible. If my family gets in an accident, it will be $37,000 my family puts out before we see any benefit from our insurance. I reminded him he would have preventive services, such as a colonoscopy, but that was cold comfort for him. The reality is that middle-class America can no longer afford the now-ironically named Affordable Care Act. So where does that leave us? President Trump--I like to say because I think he would say it-- established a contract with the American voter. President Trump said that he wanted to continue the number of folks who were covered under ObamaCare, he wanted to take care of those with preexisting conditions, he wanted to eliminate mandates because Americans hate to be told what to do by the Federal Government, and lastly, he wanted to lower costs. I think the average voter took lower costs to mean lower premiums, not a better CBO score, and lower premiums are really what those two communications are about. The second thing I will note is that he was very passionate about a particular preexisting condition that the Presiding Officer here in the Senate cares about, which is opioid addiction. And he would go to counties where there was a high incidence of opioid addiction and speak to how he wished to address their needs. So I think President Trump's proposals--his contract with the voter-- really give us hope. The question is, How do we achieve that? Well, first we have to acknowledge a couple of things. Rich Lowry is a conservative author for National Review, and he wrote a column: Basically, coverage is important. We cannot deny--no one can deny that it is important to have coverage. And if we speak--as the Presiding Officer did at lunch--about the family whose son is addicted to narcotics and the fact that now he has coverage and he is able to get off of the opioids instead of either dying, living in a gutter, or being incarcerated--that is a sign of hope. And when President Trump spoke of the forgotten man or the forgotten woman, in my mind, I think in his mind, he was referring to someone such as that. So we have to acknowledge, as Rich Lowry did, that coverage is important. My own experience as a physician supports that. I am actually going to quote somebody from my wife's experience. My wife is a retired breast cancer surgeon, and she once told me about a patient who lived in a nice section of my hometown, Baton Rouge, had a nice car and children in parochial school, paying tuition. But her husband died. He always managed the family affairs, and he died, and she ended up uninsured. She had a nice car and nice home and kids in parochial school, but she didn't have insurance. Going back to coverage being important, she began to develop breast cancer--something that is described in medicine as fungating, which means the cancer begins to eat through the skin on the chest--and she didn't know where to go because she didn't have coverage. And when the breast cancer was actually coming out of her skin is when she came to see my wife. My wife operated on her for free. The hospital wrote off the cost. But that is not the end of it because then she needed radiation therapy, she needed breast reconstruction, and she needed chemotherapy. And her only hope for survival is if she had this coverage. So we can acknowledge two things--that coverage is important but also that premiums under the Affordable Care Act have become unaffordable. I will go back to what President Trump said. President Trump said he wants everyone to be covered, care for those with preexisting conditions, without mandates, and lower premiums. That is something, whether Republican or Democratic or Independent, we should be able to get behind. How do we have a path forward? Some folks say: Well, President Trump's promise cannot be kept. There was a good article recently by Jim Capretta, a conservative economist, and he says that, basically, we can achieve these goals. The way we do it is we automatically enroll folks in the insurance program so that if you are a young person, you get a credit, and that would be sufficient enough to pay for your annual premium. You don't have to take it, but if you do, you are automatically enrolled in insurance. By automatically enrolling these young people, we expand the risk pool, which is to say that we now have a lot of healthy young folks, most of whom will not get sick, but the fact that they are in the insurance pool means that those who are older and sicker will have lower premiums because the cost of their care is spread out over the many. That is a good thing. That would increase coverage and it would lower premiums without mandates, taking care of those with preexisting conditions. I think Candidate Trump's genius was to recognize that the only way you get to lower premiums is if you expand coverage, and the only way to care for those with preexisting conditions is to expand coverage. I am pleased to say we have a proposal that is called the Patient Freedom Act, which I have cosponsored and introduced with Susan Collins, and four other of our Republican Senators have cosponsored it. The six of us propose this: that every State be given the right to choose their path forward. If you are a blue State, you can continue with the status quo; you just have to reimpose penalties and mandates. If you are a red State, you can go in a different direction where folks in your State get a tax credit, again, sufficient for the premiums. Not everybody will be eligible--typically, lower income folks--and this credit can only be used for health insurance or healthcare. If you do nothing, you end up with a health savings account, prefunded. You have first-dollar coverage. If you have to take your daughter to the urgent care center--instead of an ObamaCare $6,000 deductible, when your daughter has her earache, you have first-dollar coverage to pay that $150 to get your child seen and to buy the antibiotics. If the mother instead wishes to pool her family's health savings accounts together, their tax credits together, she could buy a richer family policy or she could assign it to her employer as the employee's contribution on employer-sponsored insurance. The patient has the power. I should say, in my medical practice, I found that if the patient has the power, the system lines up to serve the patient. By the way, just a rule of thumb: If you ever go to a hospital that delivers babies and you walk in, it is clear who has the power. The walls are painted mauve or powder blue or pink. There is a concierge to park your car because women don't like to walk in parking lots at night. And if you are pregnant, you really don't want to walk at all, so someone parks your car for you. There is a coffee shop as you walk in, and a floral shop. It is all a therapeutic experience that addresses not just the physical need but the emotional and psychological need, and that is because that system is lining up to serve her, that patient. The Patient Freedom Act incorporates that. By the way, we also have a third option. If a State doesn't want to have anything to do with this, the State can say: Take a hike; we don't want you. But generally, States have three options, and that recognizes a conservative principle that States should have the right to do what they want to do and what works best for the State. But we do require the patient have the power. Now, I will be frank. I am not sure we are going to pass meaningful reform as good as it could be with only the Republican side of the Senate. So aside from asking my Senators to join with me and my Republican Senators to promote something that fulfills President Trump's pledge, I ask my Democratic colleagues to look beyond partisanship and to say: Wait a second; wouldn't it be good if a blue State could do a blue thing and a red State could do a different plan for themselves? Wouldn't it be good if President Trump, in his contract with voters, said: Eliminate mandates but also lower premiums, which are so much of a problem for so many Americans now, while at the same time covering and caring for those with preexisting conditions. I ask my Democratic colleagues to move beyond partisanship--or perhaps they are not liking the results of the election--and into a spirit of cooperation that puts patient before party. We don't need a red plan or a blue plan, a Democratic plan or Republican plan. We need an American plan. I will finish by saying this. There is another way to lower premiums, and that is to give lousy coverage. I coined the phrase, and I didn't realize it would become so instantaneously recognized, but we should also have the Jimmy Kimmel test. I think people understand that Mr. Kimmel's child was born, and instead of being a celebration as a new life emerges into the world, all of a sudden it quickly became that the child was blue and would die. The whole medical staff comes in, recognizing that the child has a rare cardiac condition that, if not immediately operated on, would be fatal. The child was transferred, and after several surgeries already in its first week of life, apparently, is doing well. I raise that because, again, we can lower premiums by having lousy coverage. But whatever we do to lower premiums, it should pass what I call the Jimmy Kimmel test, which is that someone you love has adequate coverage for the care he or she needs when they need it. In that way, I think we can be fiscally responsible, and we can help someone like my family or the man I talked to yesterday, paying $20,000, $30,000, $40,000 for their insurance. We have to do something about that and at the same time fulfill the rest of President Trump's contract with the voters which is to care for those with preexisting conditions, to continue coverage, and to eliminate mandates. I suggest the absence of a quorum.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, I followed the remarks of the Senator from Tennessee. We speak to the American people in light of the House just voting 217 to 213 to repeal and replace ObamaCare. If there is somebody watching right now, quite likely she is concerned about her healthcare premiums. On the campaign trail--I remember this so vividly--on the campaign trail when I was running for the Senate, I was in Jefferson Parish, on Veterans Boulevard, and a woman named Tina came up. I am going to paraphrase what she said a little bit because this is a G-rated program. She said: My name is Tina, and I am angry. I am paying $500 more a month, $6,000 more a year. My husband and I have no children and I have had a hysterectomy, and I am paying for pediatric dentistry and obstetrical benefits. I am angry. If there is something right now that the average middle-class voter is saying about his or her insurance premiums, it is that they are angry. They feel they are being forced by Washington to buy things they do not need and sacrifice other parts of their budget because if they do not, they know the Federal Government will come after them with the force of law, penalizing their family, and they do not want that. So what can we do? First, we acknowledge, as the House has, that ObamaCare is not working. Premiums are going up 20 to 40 percent per year. In Eleven States, so I am told, individual markets are in a death spiral. I could go through that, which we already know. President Trump knew it. As Candidate Trump, President Trump pledged four major things: No. 1, he pledged to eliminate mandates. The Senate is committed to working with the House and the President to eliminate those mandates. Washington, DC, should not tell you what to do. No. 2, he pledged to care for those with preexisting reasons. As Senator Alexander said, it is something that touches every family. The President was particularly concerned about those whose preexisting condition was opioid addiction. We have to recognize that they will not get better unless they receive treatment. It is better to treat than it is to incarcerate or to bury. So we must honor the President's pledge there. He also pledged to cover all and to lower premiums. It is this last I wish to focus on now. How do we lower premiums? How do we say to Tina, who 2 years ago was paying $500 more a month, that her premium will be lower? Well, there are several ways. Let me focus first on lowering the cost of care. Right now, healthcare is way too expensive. If you go in for an urgent care visit, you may pay $1,500 in one urgent care center and $50 in another. As a patient, you do not know. You would never buy a car that way. Can you imagine walking into a car dealership, picking your car, and then saying: Bill me 6 months from now, and I will pay whatever you ask. No one would do that. We shouldn't ask the average patient to do it because when we hide those costs from the patient, we do not allow her to be a informed consumer. Lacking information, she inevitably pays more. So one thing I have proposed, along with Senator Collins and four other Senators--Senators from South Carolina, South Dakota, Georgia, and West Virginia--is price transparency, which is to say that when someone goes in to get their daughter's ear ache addressed, they know what it would cost at this urgent care center versus another. A good example of exactly what I am talking about--there was an article in the Los Angeles Times a few years ago about the cash price of a CT scan in the Los Angeles Basin. It would vary from $250 to $2,500, and the person purchasing the service with cash would never know. I envision a time when someone takes their smart phone and they scan a barcode, and the barcode says: You can go at midnight on Thursday and get a CT scan of your daughter for $250 or you can go right now and pay $2,500. You look at a quality code, and both have equal quality. I can see the mother turning to her daughter and saying ``Baby, we are staying up Thursday night'' because that mother knows she can take care of her family's financial health, as well as her daughter's health, just by being an informed consumer. So one way we lower premiums is by lowering the cost of healthcare, and the way we lower the cost of healthcare is by empowering patients with the knowledge of price. The second way we can manage to lower the cost of premiums is to take care of those who are sick. The Senator from Tennessee ended by speaking about our commitment to care for those with preexisting conditions. Of course it is in the interest of the patient that he or she who has cancer is able to get care for their cancer. Jimmy Kimmel just spoke about his son being born with a congential heart condition. He would have quickly died. Mr. Kimmel choked up as he spoke about it. Well, shouldn't every family have the reassurance that their child born in such a way would also have their needs addressed? I was struck that Nick Mulvaney, President Trump's OMB Director, agreed with Mr. Kimmel. This is not a Republican issue, not a Democratic issue; it is an American issue. But it is also in society's interest. I am a physician. I worked in a public hospital for the uninsured for 30 years. I tell folks, as long as that emergency room door was open, no matter what time, day or night, in through that door came folks who had all kinds of healthcare conditions. Some of them would come every week. Some of them would come twice a week. We called them frequent fliers. They may have been addicted or mentally ill. They may have had terrible diabetes which was fully controlled or bad asthma, and they would come in with an exacerbation and could not breathe. Every time they came in, there was a $2,000 to $20,000 charge--every time. But if you manage that patient through a primary care office or an attached urgent care center, what you are charging $2,000 for here, you can manage for $150 there. Not only that, when you manage it for $150 there, if that person actually works, she is more likely to hold a job, more likely to support her family, less likely to go on dependence, more likely to pay taxes. Society wins as she wins. That should be our goal. So another way to lower premiums is to actively manage the cost of disease. People always say: We want government to run like a business. Let me describe what happens in a large corporation. Take ExxonMobil. You will find that ExxonMobil has an insurance company, a third-party administrator. They look at someone who is a high-cost employee, and they actively engage in managing that patient's illness so that, one, they are better, but, two, they lower cost. We as a government should do that, which a responsible employer does as well. The last thing I want to mention is that the way to lower premiums is by expanding coverage. When Candidate Trump said he wanted to lower premiums and preserve coverage, he understood that the two are linked. If you have a big risk pool--and a risk pool is just the folks who are insured. Everybody who has insurance--that is called the risk pool. If it is big, with lots of young folks who are in their twenties, others in their thirties and forties, and then a few folks like me in their fifties, if someone gets sick, you spread the expense of that one over the many. Particularly if the many include the younger and healthier, there is a subsidy for the older and sicker. Go back to ExxonMobil. Let's imagine they have 50,000 employees. If they have 50,000 employees and 10 of them get cancer, have liver transplants, terrible car wrecks, or accidents, their premiums don't even blip. Because you spread the cost of these expensive illnesses over the many, all benefit, and cost is held down. So when President Trump pledged to preserve coverage, he was recognizing that nexus between having a big risk pool and lowering that premium. Let me finish by saying this: My commitment to Tina and my commitment to the voters of Louisiana and the people of the United States is to try to lower premiums. They cannot afford the un-Affordable Care Act. The way we can do that, which I have outlined today, includes empowering patients with the knowledge of price to lower the cost of healthcare; encouraging coverage that manages those who are sick so that those who are sick stay well and are less likely to consume expensive emergency room care, as an example, but are also more likely to live full, vibrant lives; and lastly, restoring what is called actuarial soundness, the law of big numbers, a risk poll in which if one of us gets cancer, that cost is spread over many. Mr. President, if we manage to lower premiums, we will fulfill our promise to the American people, and I look forward to working with my colleagues to fulfill that promise. Mr. President, I yield the floor.

Mr. CASSIDY

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

Mr. CASSIDY

Mr. CASSIDY. Mr. President, I rise to pay honor to Rose Landry Long. This past week, the State of Louisiana lost a caring mother, loving grandmother, supportive spouse, and, to me, my wife, and so many back home, a dear friend. Rose Landry Long left us too soon, but she will always be remembered. My wife Laura and I had the pleasure of knowing Rose and her wonderful family for over 10 years. We taught two of her grandchildren in our Sunday school class. Rose was born in Natchitoches, LA, to a French-speaking Cajun family. English was her second language. She graduated from Gueydan High School and became the first person from her family to attend college. There she met her husband, Gerald Long, at Northwestern State University. A sidenote about Gerald: He is a member of the famous Long family, which includes Huey Long, Earl Long, Speedy Long, Jimmy Long, and many others--respectively, Senators, Governors, Congressmen, and State elected officials. When Gerald was elected to the Louisiana Senate, Rose came to Baton Rouge and befriended everyone, Republicans and Democrats alike. Just out of being so concerned and loving toward others, she quickly became the center of activity and encouragement for so many. Rose had a way of reaching out to people, connecting with them and making them understand how much she cared for them. You could see each person respond to that care and love. Rose was a tremendous woman of God. She loved the Lord and was always interested in sharing her love for Him with others. She led Bible studies in every town in which she lived. In Baton Rouge, she led a Bible study for Senate staff, legislators' spouses, which my wife Laura attended. Her commitment to Jesus Christ was embedded in her values and made her the great woman we will remember. Her ability to pass these values to friends and family will live on as a part of her legacy. Rose Landry Long will be remembered as a great mother, grandmother, and wife, but more than anything, as someone who served others by loving others. Mr. President, I yield back.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, Today I wish to honor Congressman Henson Moore and recognize his years of service, including his leadership on the Battle of New Orleans Bicentennial Commission. Raised in Hackberry, LA, Henson moved to Baton Rouge where he graduated from Baton Rouge High School and later Louisiana State University, LSU. He also received his law degree in 1965 and master's degree in 1973 from LSU. Henson honorably served in the Army from 1965 to 1967 and, in 1974, was elected to Congress where he represented Louisiana's Sixth Congressional District for 12 years. In 1987, Henson was named commissioner of the Panama Canal Consultative Committee by President Reagan. In 1989, he was named Deputy Secretary at the Department of Energy and, in 1992, was named White House Deputy Chief of Staff for President George H.W. Bush. Following his retirement as president and CEO of American Forest and Paper Association in 2006, Henson and his wife, Carolyn, returned to Baton Rouge. Henson's public service and involvement with numerous for-profit and nonprofit boards has earned him many noteworthy honors and awards, among them the Secretary Gold Medal, U.S. Department of Energy, induction into the Louisiana Political Hall of Fame, induction into the LSU Alumni Association Hall of Distinction, and the chancellor's Sesquicentennial Service Award. More recently, he was honored as the 2011 LSU Alumnus of the Year. Henson also served as chairman of the Forever LSU Campaign, the most successful fundraising effort in the university's history, and in 2014 was named chairman of the Battle of New Orleans Bicentennial Commission. Fought on January 8, 1815, the Battle of New Orleans was the final major battle of the War of 1812 and a decisive victory for the United States. As chairman of the Bicentennial Commission, Henson planned and ran a number of activities throughout the New Orleans area. The commission and chairman were all volunteers; they received no money in exchange for their work, and there was no State money used for this commission. In his address on the bicentennial, Henson joked, ``When the Legislature created the Bicentennial Commission, it had the foresight to provide no money and no staff but a lot of obstruction.'' The bicentennial commission was tasked with commemorating a significant moment in both U.S. and Louisiana history. Under Henson Moore's leadership, that mission was achieved. I would like to honor and congratulate Henson for his work on both the bicentennial commission and for his service to our country and the State of Louisiana.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, today I wish to recognize the seersucker manufacturers and enthusiasts across the United States. The storied history of this uniquely American fashion dates back to 1909 when Joseph Haspel designed the first seersucker suit at his Broad Street facility in New Orleans. Louisiana is proud to have played an important part in introducing the country to seersucker apparel. During the hot summer months, Americans across the country have worn and enjoyed this lightweight cotton fabric, known for its signature pucker. Mr. Haspel said it best, ``hot is hot, no matter what you do for a living.'' In the 1990s, Members of this Chamber established Seersucker Day to honor this unique American fashion. I proudly resumed this tradition in 2014 in the U.S. House of Representatives by designating Wednesday, June 11, as National Seersucker Day. I have continued this tradition in the U.S. Senate and wish to designate Thursday, June 8, as the fourth annual National Seersucker Day. I encourage everyone to wear seersucker on this day to commemorate this iconic American clothing.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, I would like to acknowledge my experienced and talented friend from Louisiana in his maiden speech, speaking about something that reflects his experience. Briefly, his experience, aside from being an outstanding citizen, was as a secretary of revenue in Louisiana, a State treasurer in Louisiana, and an attorney and a law school professor. So now there are his committee appointments, which include the Banking, Appropriations, and Judiciary Committees, which are tailor- made for what he does. As a product of a small town and as someone who as treasurer in our State has been so aware of the economic development issues, no one would know better than he what a critical role small banks play in generating the capital and delivering the capital to a small business that grows to be a bigger and a bigger and a big business, while along the way employing more folks. So, as we as a nation grapple with how to create better-paying jobs, it is fitting that Senator Kennedy would begin by speaking directly to how to create better-paying jobs. I welcome him as a colleague. I look forward to working with him for things that would benefit our State, our Nation, and the people who live here. I yield the floor. I suggest the absence of a quorum.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, I urge my colleagues to support this joint resolution and allow Congress to review the law and make changes, if needed. It is the right thing to do. I ask unanimous consent that quorum calls during the consideration of H.J. Res. 83 be equally divided in the usual form.

Mr. CASSIDY. Mr. President, I rise with my colleagues to support H.J. Res. 83 and companion S.J. Res. 27, a resolution I introduced with 25 of my colleagues, under the Congressional Review Act, or CRA, to stop the Obama administration Department of Labor's regulation, known as the Volks rule, from expanding the statute of limitations for record- keeping violations. This regulatory scheme represents a backwards approach to workplace safety, and it is a blatant overreach by the Federal Government. Under the Occupational Safety and Health Act, employers are required to record injuries and illnesses that occur in the work place and maintain those records for 5 years. The law provides for a 6-month period for which OSHA can issue citations to employers who fail to maintain the records properly. However, it was the practice of OSHA, based on their interpretation of the law, that they were able to issue citations regarding keeping those records properly for the entire 5- year period employers must keep those records. Under this practice, OSHA took action against Volks Constructors, a firm in Prairieville, LA, in 2006 for recordkeeping violations that occurred nearly 5 years earlier--again, recordkeeping violations. This was well beyond the 6-month statute of limitations. Volks Constructors, located in Prairieville, is a heavy industrial contractor that provides manufacturing services and industrial specialties to the petrochemical and related industries. It has been in business for more than 40 years. Volks challenged OSHA in the DC Circuit Court of Appeals for those citations and won. The Circuit Court of Appeals issued a unanimous, three-judge opinion rebuking OSHA's attempt to file citations past the statute of limitations. One of the three judges was President Obama's Supreme Court nominee, Judge Merrick Garland. The Volks ruling has since been upheld by the Fifth Circuit Court of Appeals. Let me read a few of the comments from the court's opinion: ``We do not believe Congress expressly established a statute of limitations only to implicitly encourage the Secretary to ignore it.'' Another comment: ``The Act clearly renders the citations untimely, and the Secretary's argument to the contrary relies on an interpretation that is neither natural nor consistent with our precedents.'' From Judge Garland's concurring opinion: ``[B]ecause none of the challenged citations were issued within 6 months, `flowing the occurrence of any violation,' I agree with my colleagues that the petition for review should be granted and the citation vacated.'' After the court was clear in its ruling, OSHA, in order to negate such ruling and continue issuing citations beyond the 6-month statute of limitations, promulgated this regulation, the Volks rule. This joint resolution must invalidate the Volks rule. The Volks rule is a clear violation of the court's ruling and is in direct contradiction of the 6-month statute of limitations. Only Congress can amend a Federal statute. Article I of the U.S. Constitution is clear. Members of the legislative branch write the law, not the Federal departments and agencies. Overturning the Volks rule will not--will not--decrease workplace safety. The rule only changes the window during which OSHA can issue citations for recordkeeping violations. This rule is about paperwork violations and not workers' health or safety. The Volks rule also creates regulatory confusion for small businesses. By finalizing this unlawful regulation, the Obama administration created uncertainty for employers facing a confusing maze of recordkeeping standards and unwarranted litigation. The U.S. Chamber of Commerce, the Association of General Contractors, the National Home Builders Association, the National Restaurant Association, the National Retail Association, along with more than 70 State and national organizations, all support this joint resolution. I ask unanimous consent to have printed in the Record the Coalition for Workplace Safety's letter.

Mr. CASSIDY. Mr. President, I yield the floor.

Mr. CASSIDY. Mr. President, I ask unanimous consent that at 4:50 p.m. the remaining time on H.J. Res. 83 be yielded back and the joint resolution be read a third time and the Senate vote on the resolution with no interviewing action or debate.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, this weekend, the city of Baton Rouge was reminded of how precious life is and of the harsh reality of law enforcement officers putting their lives on the line to protect us. On Saturday, March 18, 2017, this past Saturday, East Baton Rouge Parish Sheriff's Deputy Shawn Anderson made the ultimate sacrifice while he and a fellow officer were conducting a rape investigation in Baton Rouge. We honor Deputy Anderson's life and recognize him for his 18 years of faithful service to East Baton Rouge Parish, the State of Louisiana, and our Nation for his service and his having been enlisted in the U.S. Army. Deputy Anderson embodied public service--taking action to help those in need. Deputy Anderson repeatedly put his life on the line to protect the lives of others. He spent 12 years as a member of the SWAT team and was recognized in 2014 for serving more than 60 high-risk warrants in the previous year with there having been no injuries or shots fired. Last year, Deputy Anderson added midwifery to his job description after having delivered a child. With baby on the way and the hospital out of reach, a Prairieville, LA, couple turned to Deputy Anderson for help. In stopping before the hospital, with baby emerging, Anderson successfully delivered a healthy child before turning over the situation to arriving EMTs. A Louisiana family asked for his help, and Deputy Anderson answered the call. This is the latest in a string of law enforcement tragedies to inflict our State. Since January 2016, Louisiana has lost 11 officers and one K-9 in the line of duty. I will read their names: Here you see Deputy Anderson. Here we have Police Officer Michael Louviere, of the Westwego Police Department, aged 26; Police Officer Jude Williams Lewis, of the New Orleans Police Department, aged 46; Police Officer Shannon Matthew Brown, of the Fenton Police Department, aged 40; Deputy Sheriff Bradford Allen Garafola, Sr., of the East Baton Rouge Parish Sheriff's Office, aged 45; Police Officer Matthew Lane Gerald, of the Baton Rouge Police Department, aged 41; Corporal Montrell Lyle Jackson, of the Baton Rouge Police Department, aged 32; Sergeant David Kyle Elahi, of the Sterlington Police Department, aged 28; Deputy Sheriff David Francis Michel, Jr., of the Jefferson Parish Sheriff's Office, aged 50; Police Officer Natasha Maria Hunter, of the New Orleans Police Department, aged 32; Sergeant Derrick Morial Mingo, of the Winnsboro Police Department, aged 35; and K-9 Duke, of the Winnsboro Police Department. Mr. President, thousands of men and women in law enforcement put on the uniform, step into the community, and risk their lives daily to keep us safe. Far too often, the price of this safety falls on these officers and their families. Deputy Anderson represents the best of law enforcement. He and his family deserve our admiration and support. His sacrifice will be remembered. The prayers of a grateful State and Nation are with his wife Rebecca, his daughter Delaney, and his son Breland. I yield to my colleague, Senator Kennedy.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, I ask unanimous consent that the Select Committee on Intelligence be authorized to meet during the session on January 31, 2017, at 2:30 p.m. in room SH-219 of the Senate Hart Office Building.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, the big debate right now, as we all know in our country, is this: How do we repeal and replace ObamaCare? It is pretty clear that the American people want something done. They voted, ever since the bill was passed, for those who opposed ObamaCare and had a desire to both repeal and replace, culminating in the election of President Trump. Now, I and Susan Collins, as well as others, have introduced something called the Patient Freedom Act, which is our attempt to replace ObamaCare. But what I want to emphasize here is the bill's emphasis upon federalism. The key feature is that we take power from Washington, DC, and give it back to patients and back to State capitols. We think that we find plenty of examples where Washington has done that, allowing States to be the laboratories of democracy. It has worked out well for all. First, let's look at the parameters that President Trump has laid out. President Trump says he wants to repeal the Affordable Care Act but replace it with something which covers everyone, takes care of preexisting conditions, does not have mandates, and lowers cost. Those are the marching orders, as far as I am concerned. With the Patient Freedom Act, we attempt to achieve President Trump's goals. Now, how do we do that? Under our bill, Congress would pass legislation this year which next year would give States one of three options. The Patient Freedom Act has something we call the better choice. That would be one option that States could choose. But really, a State would have the choice to say nothing: We don't want anything from the Federal Government. Good-bye. Get out of here. That is one option the State has, and the last option the State has is to stay with the status quo-- or the Affordable Care Act. We have actually gotten a little bit of criticism for that from conservatives, and I am saying: Why? This is federalism. We are going to repeal the ObamaCare taxes and penalties. We are repealing that. But if a State and a State capitol wants to reinstitute taxes and penalties upon the people in its State and upon the businesses in that State, God bless them. I think it is a mistake, but they should have that choice. In fact, they have that choice now. All we are saying is that you can exercise the right that you currently possess. The States would choose in 2018. They would implement their choice in 2019. By 2020, ObamaCare would be repealed and replaced. That is our goal: to repeal and replace while achieving President Trump's goals of insuring all, taking care of those with preexisting conditions, without mandates and at a lower cost. Now, by the way, let's talk a little bit about federalism. Conservatives have always thought the 10th Amendment, which grants the States every responsibility not delegated to the Federal Government, is an important consideration. That is what we are embracing here--to allow the State to choose. There are some States in which the Affordable Care Act, I am told, is working well. The folks in California and New York swear by it. It is not working in Louisiana. A friend of mine got his quote for the renewal of his and his wife's policy. They are 60 and 61, or thereabouts. It was $39,000 a year-- $39,000 a year for the renewal of a policy. Yes, Mr. President, it is $39,000 a year for the renewal of a policy. No one believes me. I put it on my Facebook page, holding up the quote sheet with their names darkened out, but you can see, it is $39,000 a year. That is the ``un-Affordable Care Act.'' As you look around the country, you can see, for example, in Arizona, there was one county that for a while had no insurance company there, and when one came in, it raised the rates 116 percent in one year--more than doubled in one year, on top of the increases in all the previous years. If California and New York say that the Affordable Care Act is working for them, keep it. It is not working for Arizona. It is not working for Louisiana. It is not working for other States in the Union. Why not take power from our Nation's capital and give it to the State capital, and allow the State capital to come up with a solution that works for that State? I read an editorial today, and it was out of Rome, GA. It pointed to the Welfare Reform Act, in which a Republican Congress and President Clinton devolved to the States many of the reforms necessary for welfare. It has been considered a tremendous legislative success. They used that example as an endorsement of the approach to federalism we are taking now. It isn't just that we give power back to the States; we also give power back to the patients. We let them choose the benefits they wish to have. We put in measures such as price transparency so that someone knows how much something costs before she has the tests performed, as opposed to being surprised by a huge bill 6 months later. With that and other means, we give power to patients. We hope all those who wish to see President Trump's mandates fulfilled to cover everyone, take care of those with preexisting conditions, lower costs without mandates, in the process of repealing and replacing ObamaCare, will endorse the federalism of the Patient Freedom Act as well as those other provisions. Mr. President, I yield back. I suggest the absence of a quorum.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, today I have the privilege, with Senator Collins, to introduce a replacement bill for ObamaCare, with her experience as an insurance commissioner and mine as a physician caring for the insured and the underinsured. Let me also give due credit to Pete Sessions in the House, who has introduced a very similar bill to come up with something that we think works not just for the people we represent but for the entire country. That is our goal. I wish to speak on the Patient Freedom Act of 2017. Our goal, if you will--I tell my staff to imagine a woman who voted for Donald Trump and doesn't like ObamaCare, but she has breast cancer. Her coverage has a $6,000 deductible, but she has coverage. On the other hand, she wants to see something different. If we just view our efforts through the prism of her care, I think we will do right by the American people. Let me say something else. Again, our goal is not to come up with a Republican plan; it is not to come up with an anti-ObamaCare plan; our goal is to come up with an American patient plan where, whoever she or he is, they can feel comfortable that, as a Senate, we are trying to do right by the American people. Let's go to first principles. First principles is, we in the Republican Party think that if you like your insurance, you should be able to keep it. I will come to that later. President Obama was rightly criticized because he pledged that, and it turns out it wasn't true. That is one of our first principles, and we mean it. Secondly, we think the States should have the power, not the Federal Government. When you speak to Americans, they want their State capital to be the kind of principal force behind how their insurance is administered, not our Nation's Capital, so we return power to both the States and to patients. Lastly, I will say that we are truly reaching out to Democrats. One of the criticisms of ObamaCare is that it was rammed through on a partisan vote with hardly a consideration given of Republicans. Senator Collins and I are absolutely open to working with Democrats for this solution. How do we begin? We first begin by repealing the ObamaCare mandates and penalties. The American people do not like Washington telling them how to live their lives. We take those mandates and penalties from both the individual and the employer and we take them off. Secondly, we work to make health care truly affordable. We do this by giving States a choice to put in what we call the State alternative. I think we are going to begin calling it the better choice. In the better choice, we would use tax credits which would go to those who are eligible and which would go into an account. If the patient did nothing, she would have a health savings account, which will be pre funded. The money would go in, actually put money into the account--catastrophic coverage and a pharmacy benefit. It is important to note that she would have power over this account. If she wished, she could combine it with her family's, these different tax credits, and they could buy a richer family policy, or she could assign it to her employer as the employee's contribution for an employer-sponsored plan. If each member of the family decided to keep their own HPSA account and one of them got a terrible illness and went into the cash portion and exhausted their health savings account, we would allow family members to donate their health savings account balance to each other to help cover that cash exposure. We do different things, but the goal is to give the patient the power. Since we are going to these health savings accounts under the better choice model, in the better choice model, we give these tax credits that go into a health savings account. The individual can donate their own money, or the employer can contribute theirs. These are some of the options they have, but whichever options they have, we institute price transparency. That is to say that when the patient goes to have her blood test, she will know the cost of the blood test before she has it done as opposed to finding out later. This came to mind this past Sunday. I had a friend in town for the inauguration. She is a physician, and she went for a vitamin D level. When she went for the vitamin D level and got the bill, it was $290. She called the hospital and said: I order these all the time. Am I really getting a $290 charge on each of these? They said: Oh, yes, ma'am. That is what we bill patients. So she went to different labs and found out the cash price for the panels of labs she typically orders. She had a patient who was from out of town and was paying cash. She said: Pay me $38; it will cover the labs. Here is the slip; go to the lab. The patient paid $38 but went to the wrong laboratory. She was from out of town and not quite sure where to go. She went to the wrong laboratory. The bill she got, which in one lab would be $38, in the other lab was $690. My physician friend called the hospital and said: You have to be kidding--$690? They reduced it to $380. There is a tenfold difference in the cash price for labs. If the patient had known that, she probably would have paid more attention to the directions. But certainly if the price of the labs were posted when she went, even if she went to the wrong place, she could have looked at the fee schedule and decided she needed to go someplace else. One of the young men who work with me said: Yes, I get it, price transparency. Who would buy a car without knowing the price beforehand? It would be great for the car dealer but really lousy for you. That is how we purchase health care now. It is great for the folks selling the service; it is pretty lousy for the person paying the cash. By this, we think we begin to use market forces to reduce costs. By the way, this is not only about saving the patient money, which is very important, but here is another example. John Fleming is a physician who until recently was a Member of the House of Representatives. He tells the story of when their office went to a health savings account, a woman who worked with him came to him and said: Dr. Fleming, I don't like these health savings accounts. Previously I had a pharmacy benefit that paid for my inhaler, and now I don't have the same pharmacy benefit. He said: Well, under their plan, at least, you can use the health savings account to pay for your inhaler, and, by the way, if you stopped smoking, you wouldn't need the inhaler. Then he walks away. Six months later she says to him: Dr. Fleming, you were right. He didn't remember the conversation. He turns around and she says: Remember when you told me if I stopped smoking, I wouldn't need an inhaler? I stopped smoking and I don't need an inhaler. So what this does is it activates the patient. It gets her or him engaged in their health care, and between that--not only do we protect the patient's pocketbook, but we also do something positive for their health care. Let me also point this out. We think most States would go for the better choice. It is possible, though, that a State will reject everything and say: We don't want Medicaid expansion dollars and we don't want any extra help for those who have lower incomes. We would give States that choice. This is not Washington, DC, forcing something on people. Let me also point out something else. Republicans believe that if you like your health care, you can keep it; if you like your health insurance, you can keep it, and we mean it. If a State decided they wished to stay on ObamaCare--I think it is a terrible decision--but this legislation would allow a State to do so. I was so disappointed. I saw that the minority leader, Mr. Schumer, criticized our bill and said things that weren't true--fake news, if you will. He said we didn't cover preexisting conditions. We do. He said the deductibles and copays would be too high, which is not true, but what was striking is that he hasn't read our legislation yet. This is what is wrong with Washington, DC. Here we have something which in good faith would allow New York to stay in ObamaCare if the people of New York decided they wished to--but we can look at double- and even triple-digit premium increases in other States. Without reading our bill, other States are going to be condemned to these double- and triple-digit premium increases because folks don't want to consider something different. This is not a Republican plan. It is not a Democratic plan. We want it to be an American plan where States can decide the best system for their State, and if it is working for New York, it can stay in New York. It is not working for Louisiana so our State would go with the better choice, I am confident. That said, please don't criticize the plan before you even look at it, and please allow those on the Democratic side who are down to one insurance company on their exchanges, with double-digit premium increases, to at least consider an option that would be good for their State. Now, folks say: Well, you don't have a mandate. We don't think Washington, DC, should be telling people how to live their lives. So how do we, under our better choice, get the kind of big insurance pool without a mandate? We give States the option to do what we call automatic enrollment. If someone is eligible, they would be enrolled. The tax credit they receive would be adequate for their premium. They would never have to pay anything out-of-pocket to have this health savings account--high-deductible health plan and pharmacy benefit. It would be covered with the tax credit they receive. By doing so, all these young males who haven't signed up for ObamaCare because they are paying too much would actually be enrolled in an insurance plan. For those who get ill or have chronic conditions, they are spreading the cost of their expensive illness over the many healthy and not just over the few sick. It restores the law of big numbers. We had an insurance plan model this, and they said they think just by doing our method of enrollment, it would lower premiums by 20 percent. That is without an individual mandate. By the way, think of the folks who will never sign up for an ObamaCare exchange policy. The mentally ill person living beneath a bridge is not going to go to a public library. If he has his W-2 form, he doesn't know where it is. He is not going to fill out a 16-page, long-line form and sign up for ObamaCare. Under our policy, he could be automatically enrolled. So if he goes to the urgent care center with cellulitis, he has coverage. If something terrible happens--if he is hit by a car, and goes to the emergency room and is admitted to the hospital, society is protected from major expenses. If he gets his life together enough, he has a pharmacy benefit providing those antipsychotics. So we actually think we would increase the number who truly need health care to the number of those who are covered. Let me finish up by speaking about our timeline. We hope that over this next year, Republicans and Democrats can come together. I understand Democrats will not vote for a reconciliation bill that begins the repeal process of ObamaCare, but that almost certainly will pass. What we hope is that sometime within this year, Democrats who live in States with only one insurance company on their exchanges, in which premiums are increasing by double--and maybe even at that time in their States triple digits--will come together to vote with us to give their State an option for our better choice. So we would pass that legislation in 2017, giving their State legislatures and Governors the option to choose this pathway in 2018; and in 2019, the States would implement their option of choice; and by 2020, it has all been done. That is our hope. Folks say Senator Collins and I are naive; that the Senate cannot overcome its partisanship; that inevitably it will be so partisan, people, without reading the bill, will criticize our legislation, saying things about it that are not true. I go back to where I started, to that woman who didn't go to college, working hard, voted for Trump, doesn't like ObamaCare but has breast cancer. She needs coverage, and she wants something done for her. We want to give her the power. We want to give her that coverage. My goal is that when this finishes, as she goes from cancer to health, the only thing she knows about her coverage is that the decisions about her health care are made in her State Capitol and around her kitchen table, and that as her breast cancer is treated, her health coverage improves. That is our goal. It is not a Democratic plan or a Republican plan. It is not a partisan plan. It is a plan for her. That is our goal.

Mr. CASSIDY

Mr. CASSIDY. Mr. President, today I have the privilege, with Senator Collins, to introduce a replacement bill for ObamaCare, with her experience as an insurance commissioner and mine as a physician caring for the insured and the underinsured. Let me also give due credit to Pete Sessions in the House, who has introduced a very similar bill to come up with something that we think works not just for the people we represent but for the entire country. That is our goal. I wish to speak on the Patient Freedom Act of 2017. Our goal, if you will--I tell my staff to imagine a woman who voted for Donald Trump and doesn't like ObamaCare, but she has breast cancer. Her coverage has a $6,000 deductible, but she has coverage. On the other hand, she wants to see something different. If we just view our efforts through the prism of her care, I think we will do right by the American people. Let me say something else. Again, our goal is not to come up with a Republican plan; it is not to come up with an anti-ObamaCare plan; our goal is to come up with an American patient plan where, whoever she or he is, they can feel comfortable that, as a Senate, we are trying to do right by the American people. Let's go to first principles. First principles is, we in the Republican Party think that if you like your insurance, you should be able to keep it. I will come to that later. President Obama was rightly criticized because he pledged that, and it turns out it wasn't true. That is one of our first principles, and we mean it. Secondly, we think the States should have the power, not the Federal Government. When you speak to Americans, they want their State capital to be the kind of principal force behind how their insurance is administered, not our Nation's Capital, so we return power to both the States and to patients. Lastly, I will say that we are truly reaching out to Democrats. One of the criticisms of ObamaCare is that it was rammed through on a partisan vote with hardly a consideration given of Republicans. Senator Collins and I are absolutely open to working with Democrats for this solution. How do we begin? We first begin by repealing the ObamaCare mandates and penalties. The American people do not like Washington telling them how to live their lives. We take those mandates and penalties from both the individual and the employer and we take them off. Secondly, we work to make health care truly affordable. We do this by giving States a choice to put in what we call the State alternative. I think we are going to begin calling it the better choice. In the better choice, we would use tax credits which would go to those who are eligible and which would go into an account. If the patient did nothing, she would have a health savings account, which will be pre funded. The money would go in, actually put money into the account--catastrophic coverage and a pharmacy benefit. It is important to note that she would have power over this account. If she wished, she could combine it with her family's, these different tax credits, and they could buy a richer family policy, or she could assign it to her employer as the employee's contribution for an employer-sponsored plan. If each member of the family decided to keep their own HPSA account and one of them got a terrible illness and went into the cash portion and exhausted their health savings account, we would allow family members to donate their health savings account balance to each other to help cover that cash exposure. We do different things, but the goal is to give the patient the power. Since we are going to these health savings accounts under the better choice model, in the better choice model, we give these tax credits that go into a health savings account. The individual can donate their own money, or the employer can contribute theirs. These are some of the options they have, but whichever options they have, we institute price transparency. That is to say that when the patient goes to have her blood test, she will know the cost of the blood test before she has it done as opposed to finding out later. This came to mind this past Sunday. I had a friend in town for the inauguration. She is a physician, and she went for a vitamin D level. When she went for the vitamin D level and got the bill, it was $290. She called the hospital and said: I order these all the time. Am I really getting a $290 charge on each of these? They said: Oh, yes, ma'am. That is what we bill patients. So she went to different labs and found out the cash price for the panels of labs she typically orders. She had a patient who was from out of town and was paying cash. She said: Pay me $38; it will cover the labs. Here is the slip; go to the lab. The patient paid $38 but went to the wrong laboratory. She was from out of town and not quite sure where to go. She went to the wrong laboratory. The bill she got, which in one lab would be $38, in the other lab was $690. My physician friend called the hospital and said: You have to be kidding--$690? They reduced it to $380. There is a tenfold difference in the cash price for labs. If the patient had known that, she probably would have paid more attention to the directions. But certainly if the price of the labs were posted when she went, even if she went to the wrong place, she could have looked at the fee schedule and decided she needed to go someplace else. One of the young men who work with me said: Yes, I get it, price transparency. Who would buy a car without knowing the price beforehand? It would be great for the car dealer but really lousy for you. That is how we purchase health care now. It is great for the folks selling the service; it is pretty lousy for the person paying the cash. By this, we think we begin to use market forces to reduce costs. By the way, this is not only about saving the patient money, which is very important, but here is another example. John Fleming is a physician who until recently was a Member of the House of Representatives. He tells the story of when their office went to a health savings account, a woman who worked with him came to him and said: Dr. Fleming, I don't like these health savings accounts. Previously I had a pharmacy benefit that paid for my inhaler, and now I don't have the same pharmacy benefit. He said: Well, under their plan, at least, you can use the health savings account to pay for your inhaler, and, by the way, if you stopped smoking, you wouldn't need the inhaler. Then he walks away. Six months later she says to him: Dr. Fleming, you were right. He didn't remember the conversation. He turns around and she says: Remember when you told me if I stopped smoking, I wouldn't need an inhaler? I stopped smoking and I don't need an inhaler. So what this does is it activates the patient. It gets her or him engaged in their health care, and between that--not only do we protect the patient's pocketbook, but we also do something positive for their health care. Let me also point this out. We think most States would go for the better choice. It is possible, though, that a State will reject everything and say: We don't want Medicaid expansion dollars and we don't want any extra help for those who have lower incomes. We would give States that choice. This is not Washington, DC, forcing something on people. Let me also point out something else. Republicans believe that if you like your health care, you can keep it; if you like your health insurance, you can keep it, and we mean it. If a State decided they wished to stay on ObamaCare--I think it is a terrible decision--but this legislation would allow a State to do so. I was so disappointed. I saw that the minority leader, Mr. Schumer, criticized our bill and said things that weren't true--fake news, if you will. He said we didn't cover preexisting conditions. We do. He said the deductibles and copays would be too high, which is not true, but what was striking is that he hasn't read our legislation yet. This is what is wrong with Washington, DC. Here we have something which in good faith would allow New York to stay in ObamaCare if the people of New York decided they wished to--but we can look at double- and even triple-digit premium increases in other States. Without reading our bill, other States are going to be condemned to these double- and triple-digit premium increases because folks don't want to consider something different. This is not a Republican plan. It is not a Democratic plan. We want it to be an American plan where States can decide the best system for their State, and if it is working for New York, it can stay in New York. It is not working for Louisiana so our State would go with the better choice, I am confident. That said, please don't criticize the plan before you even look at it, and please allow those on the Democratic side who are down to one insurance company on their exchanges, with double-digit premium increases, to at least consider an option that would be good for their State. Now, folks say: Well, you don't have a mandate. We don't think Washington, DC, should be telling people how to live their lives. So how do we, under our better choice, get the kind of big insurance pool without a mandate? We give States the option to do what we call automatic enrollment. If someone is eligible, they would be enrolled. The tax credit they receive would be adequate for their premium. They would never have to pay anything out-of-pocket to have this health savings account--high-deductible health plan and pharmacy benefit. It would be covered with the tax credit they receive. By doing so, all these young males who haven't signed up for ObamaCare because they are paying too much would actually be enrolled in an insurance plan. For those who get ill or have chronic conditions, they are spreading the cost of their expensive illness over the many healthy and not just over the few sick. It restores the law of big numbers. We had an insurance plan model this, and they said they think just by doing our method of enrollment, it would lower premiums by 20 percent. That is without an individual mandate. By the way, think of the folks who will never sign up for an ObamaCare exchange policy. The mentally ill person living beneath a bridge is not going to go to a public library. If he has his W-2 form, he doesn't know where it is. He is not going to fill out a 16-page, long-line form and sign up for ObamaCare. Under our policy, he could be automatically enrolled. So if he goes to the urgent care center with cellulitis, he has coverage. If something terrible happens--if he is hit by a car, and goes to the emergency room and is admitted to the hospital, society is protected from major expenses. If he gets his life together enough, he has a pharmacy benefit providing those antipsychotics. So we actually think we would increase the number who truly need health care to the number of those who are covered. Let me finish up by speaking about our timeline. We hope that over this next year, Republicans and Democrats can come together. I understand Democrats will not vote for a reconciliation bill that begins the repeal process of ObamaCare, but that almost certainly will pass. What we hope is that sometime within this year, Democrats who live in States with only one insurance company on their exchanges, in which premiums are increasing by double--and maybe even at that time in their States triple digits--will come together to vote with us to give their State an option for our better choice. So we would pass that legislation in 2017, giving their State legislatures and Governors the option to choose this pathway in 2018; and in 2019, the States would implement their option of choice; and by 2020, it has all been done. That is our hope. Folks say Senator Collins and I are naive; that the Senate cannot overcome its partisanship; that inevitably it will be so partisan, people, without reading the bill, will criticize our legislation, saying things about it that are not true. I go back to where I started, to that woman who didn't go to college, working hard, voted for Trump, doesn't like ObamaCare but has breast cancer. She needs coverage, and she wants something done for her. We want to give her the power. We want to give her that coverage. My goal is that when this finishes, as she goes from cancer to health, the only thing she knows about her coverage is that the decisions about her health care are made in her State Capitol and around her kitchen table, and that as her breast cancer is treated, her health coverage improves. That is our goal. It is not a Democratic plan or a Republican plan. It is not a partisan plan. It is a plan for her. That is our goal.

Mr. CASSIDY

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

Mr. CASSIDY

Mr. CASSIDY. Mr. President, I was pleased to see on the front page of the Washington Post that President-Elect Trump was speaking about how we should maintain at least the number of people covered under ObamaCare in a new kind of replacement for that portion of ObamaCare. If you will, I agree totally with him. We should fulfill this promise and do it, as he said, at a lower cost. We think we have a mechanism to do so with Senator Collins. We will speak to that today. First, let me point out, for those who are praising ObamaCare, I will say that since it has passed, the American people have been voting consistently against candidates who supported ObamaCare, culminating in the election of President-Elect Trump. So whatever folks might say about how wonderful it is, the American people are voting against it consistently. That said, there is a mandate from the American people not just to repeal but to replace. So it is not that the American people don't want to have coverage, and they want folks with preexisting conditions to have their issues addressed, but what they are concerned about is the way ObamaCare was forced upon them, with the power of Washington, DC, reaching into their own life, if you will, to their kitchen table, promising them penalties unless they comply with the Washington bureaucrats directly. That is what the American people do not like. So, first, can we maintain coverage? President-Elect Trump said we are going to have insurance for everybody. Two, will we cover more? Yes. Three, can we lower costs? The answer there is yes. Now, let's first speak to covering more Americans than ObamaCare. President-Elect Trump, Majority Leader McConnell, and Speaker Ryan have all committed to maintaining coverage for all. People speak of the advances made under ObamaCare. I will give them those advances. There are still 30 million people uninsured. Our alternative has the potential to cover 95 percent of Americans without a mandate. The way we do this is that as we return power to the States, we give States the option of saying that everyone who is eligible for coverage is enrolled unless they choose not to be. Just like when I turned 65 and I am on Medicare. I am on Medicare. I don't feel it is a mandate. No one calls me up. Indeed, if I don't want to be on Medicare, I have to call someone up and tell them I don't want to be on it. State legislatures would have the option to say you are in unless you call and tell us you are out. I say that addresses two folks who are hard to reach; the fellow whose life is so in disarray that he is living beneath a park bench and the typical 28-year-old male who never thinks about health insurance. All of a sudden he is in without even realizing he is in, until he needs it, and then he will be very pleased. On the other hand, if you don't want to be in, we make it easy to get out. By the way, I spoke of that fellow living beneath the park bench. As a physician who has worked in a hospital for the uninsured for 30 years, that was not tongue-in-cheek, and that is not a throwaway line. That person living beneath the park bench will never have his life well enough together, or almost never, to go to a public library to log onto healthcare.gov. He does not have a W-2--and if he did, he lost it long ago--to submit it to sign up. Under our program, he is enrolled. What are the benefits that he would get? He would have a health savings account so that if he goes to the urgent care center with a nail in his foot, it is covered. He has a pharmacy benefit, so that if he gets his life together while he is at that urgent care center to take an antipsychotic, he has a pharmacy benefit. Lastly, if something terrible happens, he is hit by a car or something, then he is brought to the hospital and that catastrophic coverage protects society against the cost of his hospitalization. By the way, under our plan, we give States the power. I would like to think that this is something Democrats and Republicans can agree to. When Republicans say: You can keep your plan if you like it, and we mean it, we mean it. The way we would do this is that Congress would give States alternative options. The State would have the choice. The State could go with the alternative, which we will lay out. The State could opt for nothing, no Medicaid expansion and no help for their lower income folks, or the State could opt to stay in ObamaCare. If Illinois, California, Massachusetts, New York want to stay in ObamaCare, we think they should have the right to stay in ObamaCare. ObamaCare, if it is working for your State, God bless you. On the other hand, it is not working for a State where there are double-digit and sometimes triple-digit premium increases in 1 year. So the State could choose to stay in ObamaCare, for nothing, or for the alternative, which we lay out for them. By the way, I would say that those who govern closest to those who are governed govern best. We know that the State of Alaska is far different than the State of California, Illinois, Louisiana, or New York. So let those States decide the system that works best for them. What is the timeline? This year, 2017, we would like to repeal ObamaCare but put in place the legislation which allows, in 2018, for a State legislature or a Governor to choose the option they wish and the method by which they wish to enroll the people of their State. In 2019, the State would implement the replacement option of their choice. By 2020, the repeal and the replace would have been finished. If, at a later date, a State wishes to change their option--they decided to stay with ObamaCare but on second thought now they wish to have the alternative we lay out, which I actually think would be something that might happen, they could choose that as a later option. We are not being partisan. I tell folks, this is not a Republican plan, not a Democratic plan, it is a patient plan, born out of my experience working in a public hospital for the uninsured; that if you give the patient the power, things line up. If we can make it an American patient plan, it does not matter what your State decides. I am comfortable that we will end up in the right place. Our goal is to fulfill President-Elect Trump's promise, more coverage at lower cost. We think we have laid out a pathway which can truly be bipartisan to achieve that goal. I yield the floor.