Madam President, nearly six years ago this body was on the verge of passing the Patient Protection and Affordable Care Act. Today, the Senate is poised to repeal that insultingly misnamed law.

Back in the winter of 2009, of course, we still had yet to pass the bill to see what was in it – though you didn’t need a PhD in economics to foresee that the Affordable Care Act would be a mess.

It wasn’t just conservatives and Republicans raising concerns. Every sensible observer saw the obvious flaws and inevitable disasters embedded in the rickety, ideological scheme congressional Democrats were foisting on the American people in an exercise of unprecedented partisanship.

Six years later, the Democratic Party’s dream of Obamacare has become the American people’s nightmare.

For the past five years, the American people have lived with – and suffered through – the chaos and dysfunction wrought by Obamacare’s assault on American health care. And at every step along the way, opposition to the law has grown stronger and calls for its repeal have grown louder.

Which brings us here today.

Last year, Republicans running for Congress promised to repeal Obamacare as a first step toward replacing it with real health care and insurance reform.

And it was largely on the basis of this pledge that the American people elected to put the G.O.P. in charge of both the House and the Senate.

The bill that we are scheduled to vote on later this week brings us as close to fulfilling that promise as is possible under Senate rules, pursuant to the instructions from the budget resolution that Congress passed a few months ago.

I applaud the Majority Leader for his steadfast leadership over the past several days and weeks, and I commend the Senate Budget Committee for their tireless efforts, as Republicans worked together to craft a reconciliation package that doesn’t just tinker around Obamacare’s edges, but lays the ground work for it to be erased from the books altogether.

This is the only responsible step for Congress to take – because by the law’s own standards – according to the promises of the ideologues who imposed it on an unwilling country – Obamacare has been a failure.

As its name suggests, the overriding objective and promise of the Affordable Care Act was to make health care more affordable for all Americans.

Yet nearly five years after its passage no one seriously claims the law has made it easier or more affordable for the American people to access the health care services they need.

Facts are not optional, Madam President. And the facts prove that quality, affordable health care is harder to find in America today than it was six years ago – especially for low- and middle-income Americans.

With so much political and ideological capital invested in propping up and defending Obamacare, President Obama and his allies in Congress are forced to try to skirt the facts.

Take, for instance, the left’s favorite half-truth: the notion that Obamacare has succeeded because there are fewer uninsured Americans today than before the ACA was signed into law.  

But the other salient fact routinely omitted by the president and congressional Democrats is that the vast majority of the newly insured receive their coverage through Medicaid.

The reason Obamacare supporters have made a habit of ignoring this fact is obvious. For fifty years Medicaid has served as the preeminent case study of how not to run a health insurance program.

Medicaid’s abysmal track record of failing our most vulnerable populations will only get worse as millions of new, able-bodied adults join the program.

Then there’s the fact that, in 2016, insurance premiums are set to continue their steep ascent toward unaffordability. And that goes for insurance plans on the Obamacare exchanges as well as commercial plans purchased in the private market.

Obamacare supporters have long promised that rising premiums would be, at worst, a brief detour on the centrally planned road to affordable health care.

But, as it turns out, the iron laws of economics have once again triumphed over ideological wishful thinking.

According to a survey of commercial insurance brokers conducted by Morgan Stanley, the average rate hike in 2016 for individual insurance plans will be 12.6 percent – slightly higher than the 11.2 percent increase last year. And the increase in small group rates will be 13.5 percent – up from a hike of 11.7 percent last year.  

The outlook for insurance plans on the Obamacare exchanges is just as bleak.

Last month the Department of Health and Human Services announced that insurance premiums will rise an additional 7.5 percent next year in the 37 states using the notoriously defective healthcare.gov.[1]

And that’s just the average, which obscures more dramatic premium increases for residents in particular states – like Oklahoma and Alaska, both of which are projected to see their Obamacare premiums spike more than 30 percent next year.

Compounding the continued acceleration of premium hikes is the simultaneous increase in deductibles and the narrowing of choices.

In my home state of Utah, for instance, the residents of 20 out of the state’s 29 counties are limited to only one insurance plan.

This toxic combination of rising costs and limited choices has already had serious consequences, especially for low- and middle-income Americans.

According to a recent Gallup poll, nearly one in three Americans report that they or a family member have postponed or delayed medical treatment within the past year because of the cost. And they are more likely to have done so for a “serious” medical condition than for a “nonserious” one.

What’s even more remarkable is that the proportion of Americans who delay medical treatment because of the cost has remained basically unchanged for the past decade, even as the number of Americans with insurance coverage has increased.

And it’s not just patients who have found Obamacare to be too expensive. Insurance providers are coming to the same conclusion.

To date, half of the 23 co-ops created under Obamacare have collapsed, despite receiving billions of dollars in taxpayer subsidies.

The shuttering of the once-celebrated Obamacare co-ops is not just a sign of the law’s unsustainability. It’s also a major source of stress and anxiety for millions of Americans.

Just ask the hundreds of thousands of Utahns who recently found out that Arches Health Plan, a co-op that served roughly one quarter of the state’s exchange enrollees, could not afford to stay in business next year.

The announcement came only 5 days before open enrollment began this fall, leaving families across Utah scrambling to find a new plan and hoping they can afford it – like so many before them, the collateral damage of the president’s repeatedly broken promise that “if you like your health care plan, you can keep it.”

Then there was the recent warning from United Healthcare.

United is the nation’s largest health insurance provider. It was supposed to be big enough, with enough efficiencies built into its operations, to absorb the new costs associated with doing business within the Obamacare regulatory framework.

Yet just a few weeks ago, United announced that the financial realities of its Obamacare plans may soon force the insurance giant to stop offering insurance plans through the public exchanges.

Madam President, the Affordable Care Act has been described, even by its supporters, as a “train wreck.” And it certainly looks that way, as we watch hard truths and economic realities unravel the coalition of insurers that were once great champions of Obamacare.  

But when you think about it “train wreck” isn’t quite the right metaphor to describe the calamity that is the Affordable Care Act. It misses the crucial point.

Train wrecks are accidents, aberrations, anomalies. The failures of Obamacare were no such thing – they were entirely predictable. We knew they were coming, despite the president’s repeated assurances otherwise.

There was nothing unexpected about the collapse of a national, pseudo-market in health insurance, run by Washington bureaucrats and governed by a perverse set of incentives and exemptions that encourage young and healthy individuals to stay out of the health-insurance market.

And now, nearly five years after its passage, there’s no denying the manifest failures of Obamacare.

The only question left is: what are we going to do about it?

For the Democratic Party, the answer is, as we’ve come to expect, “more of the same.”

Shield the ramshackle architecture and bloated bureaucracy of Obamacare from any meaningful reform and, whenever possible, double down.

More ill-conceived and costly regulations. More federal micromanagement of the health decisions of individuals, families, doctors, hospitals, and insurance companies. More price controls... all peddled using the same hackneyed promises and proclamations of compassion and fairness that have nearly drowned out any honest discourse during the past six years. 

Obamacare has given the American people a preview of this approach to health-care policy and they have emphatically rejected it. Which is why the Senate will soon vote to repeal the Affordable Care Act.

But saying “no” is not enough. 

Conservatives and Republicans must also offer the country a health-care reform agenda to be for.

Already there are a number of conservative leaders in Congress who have developed reform plans that would replace Obamacare’s cumbersome, bureaucratic, and expensive health system with one that is flexible, decentralized, and affordable.

We must build on these plans and advance legislation that empowers patients and families – not distant, coercive bureaucracies – to decide how they want to spend their health care dollars, and that encourages innovation and investment across all health sectors.

Repealing the Affordable Care Act is the first step in that process – the beginning, not the end, of our road to building a market-based, patient-centered health system in America.

I look forward to joining my colleagues in voting to repeal Obamacare and entering this new phase of health reform.