Keystone XL Pipeline Act -- Motion to Proceed -- Continued

Floor Speech

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Mr. COONS. Mr. President, I come to the floor today at the start of
this new year and this new Congress to speak about how we can and why
we must work together to improve the Affordable Care Act.

Since work on health care reform really began in earnest in 2009,
debate in this Chamber and across this country has too often been
defined by fantastic claims and fearmongering. In the midst of this
division, I believe that too often the experiences of real people have
been lost. While politicians on both sides cling to their sacred cows,
too many Americans become casualties of our divided politics.

On few issues has this been more true than on health care. Critics of
the Affordable Care Act seem locked into the belief that it will bring
about America's demise--despite little evidence to support them. Too
often they have been unable or unwilling to grapple with the reality of
those whose lives the law has forever changed for the better.

Now, on the other side of the aisle, we--mostly Democrats--have often
shied away from acknowledging some of the law's weaknesses. I know many
of my colleagues have been eager and have offered fixes to the law. But
without willing Republican partners, we have not made enough progress.

As I have spent time in my home State of Delaware in recent months
listening to families and other folks who have been affected by the
law--for better or for worse--it has become clear to me that this
stalemate is unsustainable. On many days, I have met Delawareans who
love the Affordable Care Act, whose lives have literally been saved by
it. But in between those encounters, I have also met many, small
business owners in particular, who want to offer health insurance to
their workers and are struggling to afford it.

This much has become clear to me: No conversation about the
Affordable Care Act and how to improve it can be complete without
reconciling the reality of the millions of Americans it has helped and
the many others for whom it falls short.

Michelle Reed is the Delawarean whom I have come to know and admire
with breast cancer and who contacted me first about this issue last
fall. She is an example of why the Affordable Care Act is so important.
Michelle was first diagnosed with cancer back in 2008 and went through
month after painful month of chemo and radiation therapy as well as
surgery.

Over the next few years since her cancer nightmare began she faced
problems that were sadly typical of how our health insurance system
used to work. At the time she was first diagnosed, she and her husband
received health insurance through her husband's employer. Her husband
is an auto mechanic and worked for a small auto body shop. But though
the insurance he got through his work was helpful for routine minor
health care needs, it was a barebones insurance policy, as she
explained it to me.

It left her and her husband with extremely high copays, straining
their family budget. Naturally her husband began looking for a new job
to provide better health insurance. But this ended up being much more
difficult than it seemed, because transitioning to a new job often
required accepting a large 3-month gap in coverage, a gap Michelle just
could not afford, as insurance companies would then deny her care
considering her cancer a preexisting condition.

At one point during Michelle's years of treatment, her husband's
employer switched health care plans and in the process missed one
premium payment. Suddenly, after months of having had steady, positive
progress in her care, without any warning or notification, Michelle
started getting bills--not just small bills but huge bills, a bill for
$23,000 for radiation.

It took her months of going back and forth between employer and
insurance company, all the while as she is also trying to overcome her
disease, before Michelle and her husband got a straight answer about
why they were suddenly facing these huge costs.

Now, let's step back for a second. Just imagine where she was.
Michelle has cancer. She is shuttling from chemo to radiation. Her
husband is working constantly to try to cover the high premiums, trying
to get all of the overtime he can. During this, they are also going
back and forth between employer and insurance company, trying to figure
out where this new high charge they cannot afford had come from.

Meanwhile, Michelle's husband was out looking for a new job with
better insurance, struggling to find one because Michelle would face
discrimination and could not get coverage. The emotional strain on a
family and a loved one battling cancer is enormous, almost
unimaginable. But if you add to that the financial and the emotional
stress caused by our relic of a health care insurance system of that
time, that is unimaginable.

Yet this is the reality that Michelle and her family faced.
Unfortunately, it is the reality that millions of Americans used to
face before the Affordable Care Act. These problems all changed last
year when the ACA exchanges came on line. As Michelle wrote to me: The
ACA open enrollment began and we could not get signed up quick enough,
although it did take her a little while because the administration's
Web site had some problems. She persevered. As she said to me in her
note: We have no problems now. We have what we need, and we need what
we have.

People like Michelle are why Democrats passed the Affordable Care Act
in the first place. It is because of the law that millions of Americans
now have access to quality and affordable health insurance that was
once desperately out of reach for them.

But the story is not complete, unless we are clear-eyed about where
this law also falls short. As the President and many have recognized,
any significant reform such as the Affordable Care Act is going to have
weaknesses and unintended consequences that only become apparent after
the law is being implemented. This has been true throughout our history
with every major event, and health care reform is no different.

In Delaware, among the many whom the law has helped, I have also seen
how some of those reforms in the costs they have incurred have hurt
small business. To the small business owners with whom I have sat down
and listened to, their employees are not labor costs or rows on a
balance sheet. They are family. They have worked together for years and
owners provide health insurance because they believe it is the right
thing to do for the workers who help their business grow.

Many of the folks I have sat down and visited with are not required
to provide insurance because they have fewer than 50 full-time workers.
They still want to do so because it is the right thing to do. It helps
them incentivize and support their best employees. Many, though, are
struggling today because of higher costs and the challenges that come
with navigating a changed insurance market.

This year the biggest issue they face is how higher quality standards
have also caused premiums to increase--often to unaffordable levels.
This has been especially true for a small State such as like Delaware,
where there is not a lot of competition in the provision of health care
or in our insurance market. Unfortunately, some of the increases are
also due to insurance companies using the health care law as an excuse
to charge more.

Some of this is simply the result of plans that now cover more are
costing more. For the most part, that is not a bad thing. But the
Affordable Care Act was designed to compensate for increased quality
with financial assistance to those who cannot afford it. In Michelle
Reed's case, this increased quality was great--almost literally life
saving. For people such as her, those insurance plans now need to meet
certain standards, and in particular, that they can no longer
discriminate against preexisting conditions.

But we have also seen that even though there is assistance to many,
some individuals and some small businesses have fallen into gaps where
they have to deal with higher costs and they are not getting the help
they deserve.

Here is where we are. The Affordable Care Act has helped millions of
Americans. It also can be improved to help many more. When we talk
about health care, it is simply dishonest to leave one side out when
talking about others.

In this new Congress, I know many of my Republican colleagues are
eager to continue the efforts of their colleagues in the House. In
their majority, I know many will seek an opportunity to vote on
repealing or dismantling the Affordable Care Act. But I ask them for an
answer to Michelle Reed and to the many Americans such as her who have
had their lives changed or even saved by this law.

I know many of my Democratic colleagues are as well eager to work
together to improve our health care system, to ensure small businesses
do the right thing and can be successful and to ensure that no American
gets left behind. We know this is possible. There is no reason to
believe that we as a body lack the creativity, the drive, and the
ability to work together across the aisle on these important issues.

Surely there is much we can do to reduce the costs through more
competition, to develop new and more efficient delivery systems and
innovative payment models. The Affordable Care Act took critical steps
to move forward in each of these areas. Millions more have health
insurance and costs across our health care system have actually
increased at the slowest rate in decades. For most, costs have been
manageable or even decreasing. But critical work remains. We now have
the opportunity, to take the next step to build a health care system
that works for every American. It is my sincere hope that we can come
together and seize that opportunity.

I yield the floor.

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