Providing for Congressional Disapproval of a Rule Submitted by the National Labor Relations Board

Floor Speech

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Mr. MURPHY. Mr. President, today is a make-or-break day for millions
of Americans who are better off because of the Affordable Care Act. As
we speak, the Supreme Court is hearing oral arguments on a case known as King v. Burwell to decide whether Americans have access to health insurance subsidies through their State exchanges or whether opponents of the law--the very same people who continued to push for over 40 votes in the House of Representatives to
repeal or undermine the Affordable Care Act, the same people who shut
down this government last year because of their obsession with
repealing the law--will win out with a paper-thin legal argument. It
would not only be a devastating blow to millions of Americans who are
currently receiving subsidies for their insurance, but it would destroy
the individual health insurance markets in those States and would
represent an incredible power grab by the Supreme Court that would
undercut the impartiality of that Court.

At the heart of this case is the Affordable Care Act, both the text
and congressional intent. The question is, Did Congress intend to allow
all Americans to benefit from affordable quality coverage across this
country, whether they are in a State exchange or a Federal exchange?

To answer that question, you don't have to leaf through many pages of
the Affordable Care Act; you can stop at the very first title, which is
on the very first page. The first section reads: ``Title I. Quality,
Affordable Health Care for All Americans.'' All Americans--not some
Americans who live in a State that set up an insurance exchange like
AccessHealthCT, but all Americans.

Before I go into a little bit of detail on this case, I wish to speak
about this little boy. His name is Devin, and I was fortunate to meet
with him just this last week. He is 8 years old. This picture is from
maybe 1 or 2 years ago during one of his first trips to Washington. He
lives with his parents and younger sister in western Connecticut.

Devin is one of about 20,000 people with hemophilia in this country.
To stay healthy and to support his active life, which includes
baseball, karate, and snowboarding, Devin has to take an injection
every other day. The injections cost about $4,000 per dose, about
$50,000 per month. Despite the challenges his disease presents, Devin
was all smiles when we talked about what he liked to do, about school,
and about how much you need to walk when you come to the Capitol to
lobby, as Devin has the past couple of years.

The benefits of the Affordable Care Act are very clear for Devin and
his family. His family will never have to worry about annual or
lifetime limits on his health care. He won't have to worry, nor will
his parents have to worry about him being denied insurance over the
course of his life just because of his condition.

It isn't hyperbole to say that an adverse decision by the Court would
be life-threatening for Americans like Devin who rely on these new
insurance protections.

Obviously, Devin and his family aren't the only ones to benefit from
this law. Just last week HHS released the final report on enrollment
and showed that 8.84 million people have signed up for coverage in
healthcare.gov States--Federal exchange States. An additional 2.8
million signed up through State-based marketplaces, such as in
Connecticut, for a total of 11.6 million people who have private health
care insurance because of the Affordable Care Act and its subsidies
which are being spread across the country. By the way, add another 10
million people who are on Medicare because of the Affordable Care Act
and we see why the uninsurance rate in this country is spiraling
downward.

The tax credits the law provided for people making less than 400
percent of poverty are critical to the success of this law because they
make coverage affordable. According to an HHS report from earlier this
month, nearly 8 in 10 consumers are getting coverage for $100 or less
after these tax credits.

In my home State, we had a goal to enroll 70,000 new individuals
through private insurance and Medicaid, and we hit over 200,000. But
the good news doesn't stop there. According to a new report since the
ACA was passed, 9.4 million people with Medicare saved $15 billion on
prescription drugs, an average of about $1,600 per beneficiary. For
preventive care, there are 39 million people with Medicare and Medicare
Advantage who took advantage of at least one preventive service with no
cost sharing in 2014. That is why the Times, USA TODAY, the Washington
Post, the Wall Street Journal, and Politico are saying the simple
message that now, more than ever, Americans understand the Affordable
Care Act is working.

Yet despite the fact it is working, opponents of the law are
continuing to try to tear it down. So let us be clear about what a
negative decision from the Supreme Court would mean. It would mean that
anywhere from 8 to 10 million Americans would lose their health care
coverage and another 5 million children could lose their coverage as
well.

Subsidies are important because the law envisions three interlocking
sets of provisions: insurance protections to fix the abuses within our
old system, the individual coverage provision to ensure we have a
viable risk pool inside insurance, and, finally, tax credits to help
people purchase insurance. Subsidies are the glue that holds all of
that together.

That is why a victory for the plaintiffs would be devastating for
everyone, not just those who receive subsidies in healthcare.gov. The
individual markets in these States would fall into a death spiral if
this law was overturned. If subsidies disappear, then people can't buy
coverage. If they can't buy coverage, then the law says the individual
mandate in those States has to disappear. If the individual mandate
disappears, then healthy people don't buy coverage and the insurance
protections, such as the ban on discrimination against people with
preexisting conditions, simply cannot work. The insurance reforms
either vanish or rates spike to catastrophic levels for people who
decide to get coverage.

Don't take my word for it. The American Hospital Association warns
that ``many more people will get sick, go bankrupt or die''--or die--if
the Court finds for the challengers. The health insurance industry says
taking away the tax credits would ``create severely dysfunctional
insurance markets'' in nearly three dozen States.

Frankly, we don't even need to talk about the detrimental effects in
these States because this is about congressional intent, and the intent
is clear. Sometimes when we try to figure out intent we have trouble
because the people who wrote the law aren't here any longer or they
have passed away. Well, there are hundreds of people who voted for this
law who are still in Congress. All we have to do is ask them. There is
not a single person who voted for this law who will tell us they wrote
the law in a way that would result in the denial of subsidies to people
who are getting health care through the State exchanges.

The plaintiffs say this is a carrot-and-stick approach; that the
intention was to deny subsidies to people in States that didn't set up
their own exchange as a way to force them to set up their own exchange.
Well, there is not a single Member of Congress who voted for the law
who says that is how it was designed.

Frankly, we don't even need to get to intent. We don't even need to
survey all the people who voted for it. We just have to look at the law
itself. The plaintiffs focus on one line that says that subsidies shall
go to State exchanges, but they ignore another line in the law that
says if States don't establish their own exchange, then the Federal
exchange becomes the State exchange. That is just as plainly written as
the one line that is the foundation of the case.

But the entire structure of the law relies on States that don't set
up their own exchanges getting Federal subsidies. Why would we even set
up a Federal exchange if there weren't going to be subsidies associated
with it? There would be no customers in the exchange if the intent of
the law was to deny subsidies to people who bought into Federal
exchanges. We wouldn't even have a Federal exchange.

Second, we would have established the insurance protections in a
fundamentally different way. We would have said insurance protections
apply to States that set up State exchanges and they do not apply to
States that don't establish State exchanges, because again, as I said
before, without those subsidies, the insurance protections simply don't
work from an actuarial basis.

But that is not how the Affordable Care Act is written. The act says
the insurance protections apply nationally, regardless of whether it is
a State or Federal exchange. Why is that? Because subsidies were going
to flow to a State no matter what kind of exchange they established.

Lastly, when Congress has historically engaged in this kind of
carrot-and-stick endeavor with States, we make it totally transparent.
We lay out in the statute here is what we expect you to do, and if you
don't do it, here are the consequences. We don't hide the consequences
to be derived at through a Supreme Court case, as is the stated belief
of the petitioners in this case.

Lastly, the plaintiffs say: Well, don't worry about it. If the
Supreme Court overturns this, we will just fix it. Congress can just
come back and fix that line. Well, Congress isn't fixing anything these
days. We can't even keep the Department of Homeland Security open and
operating. Republicans have had 6 years to provide an alternative to
the Affordable Care Act. We haven't seen anything more than a memo or a
press release. If the subsidies disappear, they are not coming back.
Congress is not fixing this problem, and 10 million Americans will lose
their coverage.

I want to finish by talking about one more story, and this is the
story of a woman who lives in Westport, CT. She works as a massage
therapist, but since she is self-employed she was uninsured and
couldn't provide insurance for herself. Last year, when the Affordable
Care Act was implemented, she found out she qualified for coverage in
Connecticut and that coverage finally gave her the opportunity to see a
doctor. She wrote the President and said:

The cancer has been detected at a very early stage, which,
with a 98 percent survival rate, has saved my life. Moreover,
the cost of this screening and minor procedure will be far
less than the cost of treating a more developed cancer. Thank
you, Mr. President, for assuring the passage of this critical
legislation. You have profoundly improved the quality of my
life.

The facts are clear. The Affordable Care Act is working. The intent
of Congress is clear: to provide subsidies to all Americans, no matter
their ZIP Code. The language of the bill is clear. That leaves us with
one conclusion. If the Supreme Court overturns this portion of the law,
it will be a plain and simple political power play. It will usher in a
new era in which the Supreme Court becomes just another legislative
body. They will be calling the authors of this bill liars and replacing
the authors' stated intent with their own political judgment.

For the sake of Devin and Ann and millions of others who would
benefit from the Affordable Care Act and for the sake of American
democracy, I hope they uphold the law.

I yield the floor.

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