Transportation, Housing and Urban Development, and Related Agencies

Floor Speech

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Ms. MURKOWSKI. Mr. President, I would like to recognize the work of the chairman and ranking member on the Transportation, Housing and Urban Development Appropriations Subcommittee for their good work on this very important appropriations bill.

I recognize that, while we haven't had a multiple series of votes on amendments on this bill, I know the floor managers have been working aggressively to process amendments and make this appropriations bill-- not only the T-HUD bill but also the MILCON bill--a good appropriations measure. So I thank my colleagues for their respective efforts, and I am pleased to see us processing appropriations bills here on the Senate floor. Affordable Care Act

Mr. President, I wish to take a few minutes this evening to talk about the Affordable Care Act and some of the impacts that we are seeing in my State of Alaska. We referred to this as the ACA, the Affordable Care Act, but most of the folks, when I talk to them back home, call it the ``un-Affordable Care Act'' because we are not seeing how it is making health care insurance--any kind of care--more affordable.

Last year, nationally, we saw a dozen co-ops fail that were created by the ACA, which literally threw people into turmoil, leaving in question if they had any insurance at all.

UnitedHealth, one of the largest providers in the country, has been forced off the exchanges in numerous States.

Just last week we had the news back home that Moda Health was going to be withdrawing from the Alaska market in 2017. What that means is that we will be a State with only one option in the individual market next year. So what that means for the some 14,000 Alaskans who are currently on a Moda plan is that they are going to be forced to change insurers next year. But I guess it is an easy choice when you only have a choice of one on the individual market there.

Then, of course, just last week we saw signs that the administration's payments of the cost-share reduction were unconstitutional. So we can only assume that is going to further exacerbate problems.

This week in the Wall Street Journal, there was an article about the ever-shrinking market for rural areas. The article mentioned a small business owner in Kodiak, AK, a bookkeeper, who is worrying about what the price of premiums will be when you are left with only one option. She made this statement:

It's going to be a monopoly, basically; ``here's the price, take it or leave it.''

That is what happens when you have just one.

As the market continues to fail in other States, we are seeing other States lose their options as well. Alabama and Wyoming are also now left with only one choice. More States may be facing this in the near future.

The Wall Street Journal article goes on to point out that the ``patchwork of coverage reflects continued instability in the individual market as companies shift their geographic footprints to avoid areas that have turned out to generate steep losses and focus on places that they believe that they can get their ACA business into the black.''

So what that means for States like Alaska that are very rural and that have some of the highest health care costs in the Nation: We are just not attractive enough to foster competition. At the end of the day, who suffers? It is the Alaskans. It is those who are seeking the care.

The administration says the market just needs to ``stabilize and evolve,'' but what about this bookkeeper in Kodiak? What about the educators out there? What about parents who are left wondering: What do we do in the meantime?

It used to be that the Federal Government broke up monopolies and worked to foster competition in order to benefit consumers, but now what we are seeing at least playing out in my State is, through bad law and failed policies, we see that same government creating de facto monopolies in the individual marketplace.

I find it deeply troubling that as these health insurance options continue to shrink, any hope of curbing the rapid increase of premium rates also disappears. We are constantly asked by our constituents: Are my premiums going to continue to increase? We are talking about monthly premiums in the State of Alaska amounting to $3,000 a month for a family. Think about that. That is not affordable in anybody's book. It is not beyond the realm of possibility given what we have already seen. Last year in Alaska, between Moda and Premera, the two that are covering on the individual market, the increases were over 30 percent, somewhere between 32 and 35 percent increases over the previous year.

I have been on the floor, and I have shared stories of hard-working Alaskans who are paying a couple of thousand dollars a month for the cheapest bronze plan that is available on the exchange. I have spoken about how the ACA has been called the single greatest threat to quality public education. The reason for that is our school districts are being faced with hundreds of thousands of dollars in fines under the Cadillac test when it is imposed. I have relayed stories from employers who are saying: I can't afford to expand my business. I won't expand my business because of the employer mandate--harming not only the businesses but the workers themselves.

The bottom line, and I hear it from all corners of the State, is that the ACA is not working for us in Alaska.

I had a group of Realtors from around the State visit me in my office here last week. One woman in the group said that she was paying $2,500 a month. She has a family of four. She has a $6,000 deductible for her coverage. She said: You know, it is really hard for us to keep making these payments every month. They don't qualify for the subsidy.

I talked to another young family from Eagle River who was forced to switch from Premera to Moda after the ACA passed because the premium increases were not sustainable, and even then, when they switched, they were paying $1,200 a month with a $10,000 deductible. So what happens when you have a deductible like that? You put off that health care.

But think about it. It just makes it so hard to run a business. It makes it so hard to pay for your day-to-day experiences.

Worse yet, for that family from Eagle River, they went from Premera to Moda because their premiums were too high. Now Moda is leaving, so they have to go back to the insurer that was too high before. This family is scrambling. What are they going do? How are they going to be able to afford insurance in the future?

As the costs continue to rise, these small businesses are wondering: How long do we keep our doors open if these costs continue at these rates?

In Anchorage, a couple who has Moda has been paying $2,500 a month, with a $10,000 deductible--an increase of $1,000 a month over their premiums for last year. Now they are going to be switching to the only company on the individual market in 2017. They are going to see yet another increase.

A woman in Anchorage whom we talked to has watched year after year as her rates increased from $500 a month to nearly $2,000 a month. She is basically holding her breath for what the 2017 premiums rates will hold. We don't know yet in Alaska. Because of the announcement from Moda, we are not sure what the increase will be coming from the other insurer.

More and more, I am hearing from folks who say that they feel it is just cheaper to simply not buy insurance, to pay the tax penalty and then hope and pray that nobody in the family gets sick. Hoping to not get sick is not a health plan. As more and more Alaskans are dropping out, costs for those who stay in go up, driving more to drop out, and you have this death spiral within the system.

The deeper we get into life under the ACA, the deeper Alaskans fall into a hole. The ACA has failed the people of our State. This one-size- fits-all approach rarely works for a State as diverse as Alaska. It certainly has not worked in the realm of health insurance.

This is not the only place where we are seeing the law failing. There is more that needs to be done to make the Affordable Care Act work for rural parts of the country that have specialized needs thanks to higher medical costs, lack of access, and now fewer insurance options.

We in Congress need to take a serious look at the trends we have seen and work on solutions that will provide the flexibility that is needed for the States to make a difference when it comes to access to affordable care.

I have consistently supported full repeal of the ACA. I voted to do so on several occasions now. But I have also recognized that it was going to be difficult, if not impossible, in this administration to do so. But I have supported steps that will reduce the burdens of the ACA and I think work to address some of the most harmful provisions in the law. One example is full repeal of the Cadillac tax I just mentioned. The Cadillac tax will only worsen conditions in Alaska, with nearly 62 percent of customers who will be facing that tax if the Cadillac tax were to be implemented. Again, I repeat, in our State, not only are our health care costs so high, but our insurance costs are so high.

Whether you are in what would be considered a Cadillac plan because of the benefits or it is just because you are paying so much for it, it is assumed that those benefits are good. Sixty-two percent of the folks in Alaska would be impacted by this tax. It is a prime example of the ACA hurting small, rural States, because so many of us have more expensive health care due to the remoteness and due to our lower population size. Then those States are forced to take money away from things, like our school districts, where they are trying to put the money into public education, into other services, to pay for the cost. So our State suffers, boroughs suffer, our schools suffer, and our Alaskan families suffer.

As we look to the end of this administration and looking to next year, I would hope that we can seriously address the problem that the ACA has created for so many areas of our country.

For rural States like Alaska, the approach to health care needs to focus on more than forcing people to just buy insurance and, unfortunately, buy expensive insurance. We need to work to find solutions to these issues, whether it be through the creation of a nationwide insurance pool so that policies are not limited to one State, as they are currently. Right now, as I say, Alaska is not a very attractive market. We have small numbers. We have high costs. Who is going to come? How are we going to get a greater pool?

We need to look more critically at how we improve the cost of transparency of medical procedures. We need to look critically at these special enrollment periods and see if people are finding loopholes that allow them to game the system.

Expanding both health savings and flexible spending accounts will allow people to save what they think they should and make the choices for themselves instead of the government forcing things on individuals.

When we think about those areas where we can save money through not spending it in the first place--an ounce of prevention is worth a pound of cure--we should be incentivizing people to live healthier lifestyles in order to prevent and bring down the incidence of chronic disease. Type 2 diabetes--largely preventible through lifestyle changes--costs an estimated $176 billion a year. Obesity-related illnesses cost an estimated $190 billion a year. A recent study found that a 10-percent drop in smokers could save $63 billion in health care costs per year. It makes zero sense to be paying providers to treat these problems after they have arisen rather than trying to focus on the front end, paying for lifestyle changes and case management that would significantly reduce the cost of treating these diseases.

I have been working to find solutions that will help support Alaska's rural needs, especially those related to access and workforce development because if we can improve the overall access to treatment and options to medical providers, we then take steps to reduce the cost of medical procedures.

I have supported the Family Health Care Accessibility Act that will improve the care provided by community health centers by enabling them to utilize volunteer primary care providers. Community health centers-- I think so many of us recognize the benefits and the crucial role they serve in meeting the needs of rural and underserved communities, allowing patients to receive local treatment instead of being forced to travel far from home for treatment.

Steps like these that help to improve access are just some of the ways I think we should be rethinking our approach to health care in the broader sense as we seek to alleviate the burdens that have been imposed by the ACA.

I have continued over several Congresses now to introduce the Medicare Patient Empowerment Act. This is legislation that would give patients the option to negotiate with their provider. Medicare would pay the typical fee the patient negotiates for the difference there, but we face a very unique situation in our State. Again, a one-size-fits-all prescription doesn't work for us. We have incredibly low reimbursement rates for Medicare in Alaska, so you have very few providers that will accept Medicare. When you are newly Medicare eligible or you come into the State, it is tough to find anybody who will see you.

If there is some flexibility to negotiate prices, what we are trying to do with this bill is cut through the redtape, allow Medicare beneficiaries to benefit from increased access, and enable patients to have the relationships they have built with their physicians. We have a very fast-rising senior population in the State, and it is going to be increasingly important to make sure they have the option to seek the care they need.

I do not support compulsory health insurance but do believe individuals with preexisting conditions should receive care. As we discuss these important issues in the Senate, I continue to work to address--again--these issues that have presented themselves with implementation of the ACA. So working to a place where we fully repeal and replace the ACA is where we need to be.

There have been several Republican proposals that would not only replace this unworkable law but replace it with consumer-based reforms. Senator Burr of North Carolina, Senator Hatch of Utah, and Senator Cassidy of Louisiana all have been working on important measures that take steps to get us to a place where what we are talking about is affordable health care, a reality that works for all Americans, whether you are in Alaska or you are in North Carolina.

Obviously, there is much work in front of us. Again, it is important to recognize the frustration so many are feeling as they are seeing their costs increase, their access going nowhere, and let them know we continue to work on these very difficult issues. Alaskans deserve it. Americans deserve it.

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