objection. mr. cornyn: thank you, madam president. i know we're all glad to be back in washington, d.c. at work after a few days back home, and i know many of us are eager to continue our work to rescue the american people from the failures of the affordable care act, otherwise known as

obamacare. the failures of obamacare are well dowcted and while they don't -- documented and while they don't necessarily apply to everyone, in particular individuals and small businesses in the so-called individual market have seen a meltdown of the insurance exchanges. the presiding officer in her home state of ie warks you've had insurance -- iowa, you've had insurance companies pulling out to the point people can't find an insurance carrier that will sell a policy that qualifies under the affordable care act. that is because the affordable care act was, unfortunately, a partisan exercise and a failed big government experiment that has failed. all you have to do is look at the promises that were made at the time that obamacare was being sold back in 2009 and 2010. but the president himself said that if you like your doctor, you can keep your doctor. well, that proved to be not true. he said if you like your policy,

you can keep your policy. well, that proved not to be true as well because people saw their policies canceled because they couldn't qualify under the new requirements of the affordable care act, but perhaps the thing that stung the most was the fact that the president said back in 200 the and -- 2009 and 2010 take an average family of four would see a reduction in their health insurance premiums by an average of $2,500. well, what we've seen since 2013 is a 105% increase in insurance premiums under the affordable care act. and so instead of seeing a cut in their out-of-pocket costs of $2,500, what people have experienced, families of four, are an insurance premium of $3,000. now, some people may be able to absorb that cost but most people i know cannot.

what it's meant is they've had to reprioritize their spending so they've had less to spend on other things in their life. but we do know that based on the promises made at the time the affordable care act was being sold to the american people, that it has been a failed experiment. and so the question is what are we going to do about it? what are we going to tell the folks in iowa who can't find an insurance policy or an insurance company who is willing to sell them an insurance policy on the individual market? what are we going to tell people in texas who have seen their premiums go up by 105% since 2013, have been priced out of the market? or who found that the only policy they can afford is one with deductibles that are so high that basically they are denied the benefit of their insurance at all. so what are we going to do about it? well, a number of my colleagues

have noted that even if hillary clinton were elected president of the united states, we still would have to be revisiting the failures of the affordable care act because the failures are all too obvious and public and can't be denied. but despite that and acknowledging many of obamacar obamacare's -- many of our friends across the aisle, in fact all of them so far here in the senate have made clear they want nothing to do with providing any help or any aid to the people who are being hurt by the failures of obamacare. they don't want to lift a finger to help the people who are who can't find insurance, who can't afford it, and policies that they're forced to buy limit them in a way that they simply have decided to opt out. so instead of working together with us, you would think they would do that just would be logical thing to do, because

their constituents are the ones being hurt in many instances. instead they fought us tooth and toenail to preserve the status quo in health care that's failed so many people across the country, and they've made dubious claims about our efforts to address the problem to the best of our ability. it reminds me of the old saying, don't let the facts get in the way of a good story and what our friends across the aisle have simply washed their hands of any responsibility, even though they're the ones that passed the affordable care act and created this failed experiment and put so many people in distress. and now they're in the process of attacking those of us who are trying to help people who are hurting rather than lending a helping hand and working together with us in a bipartisan way. let me talk just a minute about medicaid because this is one of the big attacks that are being made by our democratic

colleagues on our efforts to try to salvage health care for people who are hurt by the failures of the affordable care act. much of the conversation has revolved around medicaid and rightly so. 4.7 million folks in my home state currently rely on medicaid. it's an important safety net program for people who are in low income status so for poor folks. for those americans, i want to make sure they understand notwithstanding all the scare tactics, medicaid is not going away. now, one of the common refrains is that medicaid spending is slashed in the better care act, but the nonpartisan congressional budget office estimates that medicaid spending will grow by $74 billion over ten years. so when they talk about it being cut, it actually grows by $71

billion over four years. madam president, i would also point out there's some that think that the current rate of spending of -- on medicaid can go forward unabated without any changes, and that's simply not true. we know according to the congressional research service, that medicaid spending across the country totaled $494 billion in 2014. i guess it's the last year for which full statistics are available. $494 billion. if we do nothing to check the rate of growth of medicaid spending in 2023 it will be $835 billion. so you go from $494 billion to $835 billion. we simply cannot keep up with that pace of spending. many of us, the presiding

officer being one of them, are concerned about cuts in our military which is the one thing that the federal government has to do because nobody else could do it. and right now we've seen during the last administration cuts of about 20% in our defense spending. well, when you have runaway spending and entitlement programs like medicaid where nobody is placed on a budget and forced to spend wisely and efficiently essentially by forcing the federal government to spend $835 billion for medicaid spending alone, that's going to crowd out a lot of other meritorious and important spending, including for defense spending as well. so we need to make sure that medicaid is there but that medicaid is put on a responsible budget that grows year after year and in fact during the life of this particular bill over the next ten years, it will go up $71 billion. but here's another thing.

our friends across the aisle act like medicaid is the very best program to come down the pike. well, it's not. and there are a number of reasons for that. one is that medicaid recipients don't always get the quality of care or the access to care that we would hope for. that's because the states which set the rate of reimbursement of doctors for medicaid beneficiaries set it so low that it is roughly half the amount that is reimbursed based on private insurance. and that's the reason why in 2000, 67% of texas physicians accepted new medicaid patients. today it's 31%. so if you're on medicaid, there's two-thirds chance that you won't be able to find a doctor to see you as a medicaid beneficiary. what we have done instead in the better care act is particularly

for the adult, single adult population between 100% and 135% of the federal poverty level is we said we'll give you a refundable tax credit you can use to buy private insurance. private insurance is highly preferrable to medicaid because for one thing, it's -- it reimburses physicians at a higher rate and gives people greater access to physicians and hospitals and greater quality of care. in my state alone in the state of texas, according to the kaiser family foundation, as many as 600,000 new low income texans will benefit from the provisions of the better care act. it will help qualify them for a tax credit not available to them under obamacare. but simply throwing money at medicaid won't help people at all. we need to reform medicaid, make it more efficient, and, frankly,

one of the things i did back when we were debating the affordable care act in the senate finance committee, i actually introduced an amendment that said members of congress would go on medicaid. well, it failed, but the point i was trying to make if members of congress were on medicaid, we would fix medicaid. but right now it's subordinate standard health care for -- subordinate standard health care for the reasons i mentioned and the doctors in my state refused to see a medicaid patient because it pays them so far under the standard of private insurance or even medicare. but by providing low income americans access to private insurance instead of medicaid, we can assist those who were previously left out of the health care market and will now be able to purchase a plan of their choice perhaps for the first time. but unless we act, we're going to continue to see skyrocketing premiums and deductibles and

lost coverage. as i've said, the american people were told time and time again that under obamacare, costs would go down and they would be able to keep their doctor which ha was proven not o be the case. i mentioned before on the floor of the senate that in my previous life as attorney general of texas, we had something called the consumer protection division. and if some business made false claims to the service or product that the united states government made to the american people when it came to their health care, we'd take them to court and we'd win because it is simply a deceptive trade practice in that context. it is deception. it's deceit. and, unfortunately, the american people were bamboozled by promises that were not kept. but we also know that the obamacare taxes, about $1 trillion in new taxes that were imposed to pay for obamacare, has ultimately been saddled --

those costs have ultimately been saddled on families. when all these new taxes were passed, they acted as though it would just simply be absorbed by somebody. simple economics mean that ultimately the consumer, the people who actually pay the tab, they're the ones who end up paying the tax. but some of our colleagues on the other side recognize the destructive nature of the affordable care act tax scheme. for example, five democratic senators including my colleagues from minnesota voteed to repeal the medical device tax just two years ago. the medical twice tax was a really draconian form of taxation. it wasn't based on income. in other words, you could deduct your expenses and pay just taxes on your income, your network. it was a gross receipts tax.

, that you've certain -- everything that you've earned before you deductible deduct your cost of business will be taxed at the going rate. that was true of the medical device tax. the tax on medical devices meant not only the job to produce those medical devices move offshore, in the one texas-based company, they moved their business to costa rica, in order avoid the taxes, success bea simply -- because they simply couldn't ford afford to pay the taxes. but it also was a tax on innovation, and that's the reason we saw a department response to -- we sue bipartisan response to repeal the tax two years ago. this tax has saddled consumers with higher costs. so by repealing those taxes in the better care act, we not only will lower the bill at the pharmacy or the doctor's office, but we encourage competition,

and that's common sense and that ultimately benefits consumers. our plan also frees consumers from government mandates requiring them to buy insurance they don't want and they can't afford. this way families can choose what works best for them, free from the penalty by the government. and for some individuals they may choose to go with no plan at all. the dirty little secret about the affordable care act is that it can't work without a government mandate that you buy government-approved health insurance or else you pay a penalty. there is -- i can't think of any other instance where the government says, you do what we say or we're going to punish you and penalize you as the affordable care act does. but even with the individual mandate and this threat of a

penalty, we know that about 28 million americans are currently not covered by insurance. many of them are covered by so-called hardship exceptions. about 6.5 million of them just pay the penalty because it is cheaper than it is to buy the insurance because the prices are so high. so when some of the critics say that without this economic gun to the head of a penalty that people will choose not to buy insurance for themselves, well, that's a choice that they will make as americans. as americans we believe in freedom of choice. when the marketplace provides a product that they believed as value at a price that they can afford, that's when consumers buy a product or a service. but they shouldn't have to do it just because the government forces them to do so and penalizes them if they don't. so the better care act gives people the right to not buy

something that they don't want. the washington-forced mandates are gone. the nonpartisan budget office has estimated that under our plan also that average premiums will decrease by nearly one-third in three years. these are some of the important facts that we need to be debating, not the misrepresentations that unfortunately seem to fill the void. madam president, i've shared multiple stories from my constituents back home in the last few weeks on the floor, and i plan to keep doing that as we continue our work on this legislation. the stories that i've heard, that my colleagues have heard, are what have inspired me and motivated me from the beginning of this entire process. that in fact sour job -- that in fact is our job to represent our constituents. i would encourage all of our colleagues to listen to their own states and share the trials of their constituents as well because the status quo is simply unacceptable. the democratic leader has said as much.

he said, if we set aside the better care act and are actually interested in helping, quote, fix obamacare, that they're willing to do that. but you no what that is? basic what i that represents a huge -- what that represents is a huge multibillion-dollar bailout of insurance companies without any of the reform. that's what our democratic colleagues are supporting by their failure to engage with us in making sure the reforms in addition to the other things that we do. and the other alternative plan you might ask, well, what -- if obamacare didn't work as tied, which it clearly hasn't, then something needs to be done, then what does that something look like? in the case of our friend, the senator from vermont, senator bernie sanders, he said, i've got an idea. let's just make the federal government provide insurance coverage for everything, single-payer.

well, that's simply a solution that we can't afford when people look at the trade-offs. and it would essentially supplant all of the private insurance that people get from their employers and require incredible increases in taxes in order to do that across the board. so i don't think that's an alternative that our friends across the aisle want to support. they love the mandate, they love penalizing free american citizens when they don't purchase a product that the government mandates, but they're not going to defend that. they're not going to defend that. and they certainly won't advocate at least openly here on the floor for a single-payer system. we saw in one committee of the congress -- or the legislate neurocalifornia recently -- or the legislature in california recently, one committee in one house, the estimated cost of the single-payer system in california alone was double the

annual budget of the entire state. so you can imagine what the numbers would be here at the national level. our draft bill, like any piece of legislation, can be strengthen and we would invite anyone in good faith who is interested in strengthening the bill to work with us to do so. we're going to continue to talk and listen and exchange ideas on how we can continue to make improvements. but, in the end, the choice is clear. you either ultimately support obamacare and the status quo or you're willing to try to work with us to do something better. that provides more affordable health care from the doctor and health care provider of your choice. that's simply the choice that people are going to have. a no vote against an alternative is simply a vote for the status quo under obamacare, and we know where that's going to lead. it's going to lead with a big

multibillion-dollar bailout of the insurance companies without any reform. that's what our democratic colleagues are hoping for, if we are unsuccessful. but we think there is a better way to approach this and one that brings down cost and maintains choices and the freedom of choice in the individual consumer. so we're going to continue to plow ahead with their help or not because we think it's our duty to do so. and we have confidence that working together we can come up with a better care plan that suits the needs of americans