[Congressional Record Volume 163, Number 23 (Thursday, February 9, 2017)]
[Senate]
[Pages S1012-S1017]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                       Nomination of Neil Gorsuch

  Mr. President, I also come to the floor today to talk about the 
President's nominee for the Supreme Court, Neil Gorsuch. Ever since the 
President made that nomination, we have had an outpouring of support 
for this nomination and not just those of us in Wyoming--of course, 
because his mom was born in Casper, WY--but there has been an 
outpouring of support all across the country and actually across the 
globe.
  The Economist magazine out of London wrote: ``Neil Gorsuch Is a Good 
Pick for the Supreme Court.''
  USA Today had a story with the headline: ``Neil Gorsuch, Stellar 
Resume and Scalia-Like Legal Philosophy.''
  There was even an op-ed in the New York Times by a former Acting 
Solicitor General in the Obama administration. It was an op-ed by Neal 
Katyal under the headline: ``Why Liberals Should Back Neil Gorsuch.'' 
This top Obama administration official called Judge Gorsuch ``one of 
the most thoughtful and brilliant judges to have served our nation over 
the last century''--over the last century.
  He went on to say that ``if confirmed, Judge Gorsuch would help to 
restore confidence in the rule of law.''
  I mean that, to me, is what it is all about--the rule of law. And 
that is from a former Obama administration official who knows the 
Supreme Court.
  I hope to be able to sit down soon with Judge Gorsuch to talk about 
his views. He and I had a brief visit today as he was heading from one 
Senator's office to another.
  Everything I have seen in his background tells me that he has the 
temperament and the experience to be an outstanding Justice on the 
Supreme Court. His background as a judge gives us powerful evidence of 
the kind of Justice that he will be.
  In 10 years on the U.S. Circuit Court of Appeals, he has authored 
hundreds of opinions and dissents, and you can be assured that these 
will be dissected. This record will give Senators ample evidence of 
exactly how Judge Gorsuch views the role of the courts in applying the 
law.
  From what I have seen so far, he appears to take the law and the 
Constitution at face value. He doesn't treat them like blank pages on 
which he can rewrite the laws the way he wishes they were. As he wrote 
in one opinion: ``Often judges judge best when they judge least.''

  This view of judicial restraint in every example I have seen from 
Judge Gorsuch's record is squarely in the mainstream of American legal 
thinking today. You don't have to take my word for it. There is actual 
data to prove it.
  There was an editorial in the Wall Street Journal yesterday with the 
headline, ``Gorsuch in the Mainstream''--``Gorsuch in the Mainstream,'' 
yesterday's Wall Street Journal.
  The editorial cites a thorough study of something like 800 different 
opinions that Judge Gorsuch has written since joining the court of 
appeals. Less than 2 percent--less than 2 out of 100 opinions even drew 
a dissent from his colleagues on the bench, and 98 out of every 100 of 
his decisions were unanimous. This was on a court where seven of the 
active judges were appointed by Democrats, and only five were appointed 
by a Republican. The Wall Street Journal says that of at least eight 
cases considered by Mr. Gorsuch that were appealed to the Supreme 
Court--appealed to the Supreme Court--the Supreme Court Justices upheld 
his results in seven of the eight--seven out of eight. Four of them 
were unanimous in front of the U.S. Supreme Court. So if you actually 
look at his record, I think it is clear that this is a judge who is 
very much in the mainstream.
  CNN did a story on Judge Gorsuch, and they said that he is a laid-
back, fly-fishing, fourth-generation Coloradan who also happens to have 
an Ivy League education, a brilliant legal mind, and an established 
judicial record.
  I mentioned his established legal record, and I think it is also very 
important that he is a fourth-generation Coloradan. He would bring to 
the Supreme Court a much needed perspective from the Rocky Mountain 
West. Among the current Justices, only Justice Clarence Thomas is from 
somewhere other than New York or California. It is important that we 
get this kind of viewpoint on the Court.
  Judge Gorsuch is smart, fair, very well qualified. CNN mentioned his 
education, and it really is very impressive: Columbia University, 
Harvard Law School, a Marshall scholar at Oxford University. He was 
also confirmed to the circuit court by a unanimous voice vote of the 
U.S. Senate right here.
  None of this seems to matter to the Democrats today--not the 
intelligence, not the distinguished career, not that he is squarely in 
the mainstream. None of it matters to some of my colleagues on the 
Democrat side of the aisle. They were sharpening their knives for 
anyone--anyone the President might nominate, regardless of their 
qualifications. They wrote their press releases months ago, full of 
attacks on a person most of them had never met. It is what Democrats 
always do when a Republican President nominates someone to the Supreme 
Court. It is exactly what they promised to do this time as well. Even 
before President Trump was inaugurated, Democratic leader Chuck Schumer 
said that his party would fight ``tooth and nail'' to block the 
nominee. He said he was going to do his best to ``keep the seat open.''
  Senator Schumer met with Judge Gorsuch the other day. He complained 
that the judge did not answer questions about some issues that are in 
the news and before the courts, things like the so-called Muslim ban. 
Well, according to the Code of Conduct for United States Judges--the 
code of conduct for judges--a judge is actually prohibited from making 
public comment on the merits of a matter pending or impending in any 
court. Well, there are certainly ongoing court cases about a number of 
things that Senator Schumer asked about, so I think it is a very good 
sign that Judge Gorsuch would refuse to comment on these.
  Democrats in the Senate are being told by the far-left elements of 
their political base to try to block this nominee. Many of these 
Senators are doing everything that they can to comply. Liberal 
activists have been planning a multimillion dollar lobbying campaign 
against this nominee or any nominee ever since election day. The 
reaction of these activists on the left has been hysterical, it has 
been irrational, and it has been disgraceful.
  I hope the Democrats in the Senate will reject these calls from their 
base and will give this nominee a chance. I hope that they will take 
the time to consider his qualifications and that they will actually sit 
down to talk with him before they rush to condemn him.
  I know I look forward to sitting down with the nominee and discussing 
his views more fully. Everything I have seen so far suggests to me that 
it will be a very good conversation.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Delaware.
  Mr. CARPER. Mr. President, I don't speak often on the floor, but it 
seems that whenever I do, you are the Presiding Officer. I have said 
this before, but you are a glutton for punishment. I thank you for your 
willingness to show up day after day.
  I was going to talk a little bit about the Affordable Care Act as it 
relates to Congressman Price, who has been nominated to be Secretary 
for the Department of Health and Human Services.
  Before I do, I want to follow up on the comments of my friend Senator 
John Barrasso, who is the chairman of the Environment and Public Works 
Committee on which we both serve. He is the senior Republican, and I am 
pleased and really privileged to be the senior Democrat alongside him.
  What I would just say in response is--if Senator Schumer were here, 
he would be perfectly capable of thinking for himself and defending 
himself, but I would say this: On the question of whether Judge Gorsuch 
will have a

[[Page S1013]]

hearing, I think he will have a hearing, and he should have a hearing. 
On the question of whether there will be a 60-vote margin--the last 
couple of people who have been confirmed for the Supreme Court, both 
Democrats, were confirmed by more than 60 votes.
  I don't know Judge Gorsuch well, but I do know Merrick Garland pretty 
well, and I must say I am disappointed that he never got a hearing, 
although he was nominated by Barack Obama when there was almost 10 
months remaining in President Obama's term. Not only did he not get a 
hearing, a lot of folks on the other side of the aisle couldn't find 
the time to meet with him, and he never had a vote--a 60-vote margin or 
even a simple majority, 51 votes.
  For us to now hear it is important that Judge Gorsuch get a hearing 
and get an up-or-down vote, I just wish I had heard those voices here 
over the last year when a very good man was treated I think very 
badly--very badly. That was Merrick Garland. That is for another day, 
but I couldn't let the moment pass without saying anything.
  Mr. President, to back up to about 30 minutes ago, I was talking 
about the Affordable Care Act, and I yielded to Senators Tester, 
Isakson, and Barrasso. Now I want to come back to where I was.
  I am a Democrat. I am proud to be a Democrat, a retired Navy Captain, 
and I went to graduate school, undergraduate at Ohio State, Navy ROTC, 
studied economics. After the Navy, after the Vietnam war, I moved from 
California to Delaware, got an MBA at the University of Delaware and 
studied some more economics and some other things in their MBA program. 
I became State treasurer, Congressman, Governor, Senator.
  I have always been intrigued by how we harness market forces. How do 
we harness market forces for good public policy outcomes? You don't 
always hear Democrats say that, but that is the way I think. I think if 
we can find ways to harness market forces and achieve a good public 
policy outcome, that is a good thing. We ought to try to find them, and 
I think if we can, we can generate good bipartisan support for our 
ideas. At the end of the day, if it meets our goals, so be it.
  I keep going back to 1993, which is when John Chafee, whom I knew--I 
was a Congressman then. Actually, in 1933, he introduced his own 
version of the Affordable Care Act, cosponsored, I think, by 20 other 
Republicans and maybe 3 Democrats. Among the Republican cosponsors of 
John Chafee's legislation--which actually looks like the Affordable 
Care Act--were a couple of Republicans who are still here. One of them 
is the chairman of the Finance Committee, Orrin Hatch, and the other is 
the fellow on the Finance Committee who is actually senior in terms of 
the Finance Committee to Orrin, and that is Chuck Grassley. They 
cosponsored the 1993 legislation that Chafee introduced.
  I want to take just a moment and go through the five key provisions 
in Senator John Chafee's 1993 legislation. I will start here at the 
bottom of this chart.
  One of the things we see in the Chafee legislation was the idea that 
folks who did not have access to health care and were not part of a 
large group plan would have an opportunity to have the benefit as we do 
in the Federal Government and, like half the people who get health care 
in the country, get coverage through a large group plan. So there would 
be a large group buying access to health care coverage for a lot of 
individual people who happen to be in that group; maybe they work for 
the same employer.
  But Senator Chafee came up with a good idea, and the idea was that we 
might want to create in each State something called exchanges or 
marketplaces where people who didn't have coverage could find coverage 
and be part of a larger group and enjoy the benefits of being part of 
that larger group. I think they called them exchanges. They may have 
called them purchasing groups. But it was a 1993 idea.
  He also said that folks who got their coverage through one of these 
exchanges or marketplaces in 1 of 50 States should get some help in 
buying down the cost of health care premiums if they are getting 
coverage through the exchange or the purchasing pool in their State, 
the marketplace, and we would call that a sliding scale tax credit. The 
lower the income of the person buying their health care coverage 
through the marketplace, the bigger the tax credit, and as a person's 
income goes up, the size of the tax credit goes down and eventually 
goes away. That was in Senator Chafee's legislation in 1993.
  Also in Senator Chafee's legislation was something called an 
individual mandate, which basically said that under his proposal, 
people had to get coverage. You couldn't make somebody get coverage if 
they absolutely refused to, but the idea was to penalize people in one 
way or another, maybe with a fine or something like that, and say: If 
you don't get coverage, we can't force you to, but we are going to 
impose a fine or penalty on you, and over time, that fine or penalty 
will increase. Maybe eventually you will say: Well, I am paying this 
fine or this penalty, and it is going to be pretty expensive. Maybe I 
ought to get health care coverage to avoid the penalty. That is called 
the individual mandate.
  Chafee's mandate was that employers of a certain size would be 
required to provide health care coverage for employees. It was a 
mandate, not for all employers but for a number of them when they 
reached a certain number of employees.
  Then the fifth provision in the Chafee plan in 1993 was a ban on 
preexisting conditions. Some know that the Presiding Officer is a 
physician in his State. And a number of people in my State, I am sure 
in his State as well, lost coverage because they had a preexisting 
condition. Maybe they had coverage for a while, and they lost coverage 
or lost their job or something like that, and then they had a condition 
that could be a scare with colon cancer, breast cancer, prostate 
cancer--you name it--and they eventually planned to sign up to get 
health care coverage, and because of the preexisting condition, they 
couldn't get it. So what Chafee said in his proposal to insurance 
companies was: You cannot refuse to provide coverage for someone 
because they have a preexisting condition.
  The health insurance companies said: Well, if you are going to put 
that preexisting condition on us, then we have to have the individual 
mandate. In these State exchanges you are going to create, Senator 
Chafee, we have to make sure there are people in the purchasing pools 
in each of the States who are young and invincible, like our pages 
sitting here in front of me today--young, healthy. They just can't be 
people that are old and infirm and not well because they will consume a 
lot of health care costs. We need a mixed pool that is insurable so 
insurance companies can insure this pool for health care and not lose 
their shirts.
  That was the long and short of it in the Republican plan from Senator 
Chafee, with some bipartisan support in 1993.
  Mitt Romney became Governor of Massachusetts sometime after the turn 
of the century, and he was interested in running for President. He is a 
smart guy. Some of us know him, some better than others. But he is a 
very smart fellow. He is smart enough to know that if he wanted to run 
for President some day--and he did--one of the things he could do that 
could help bolster his chances was to be able to demonstrate after 
years and years of people talking about providing health care coverage 
to just about everyone in our country, he could actually say: We did 
this in our State. We actually provided coverage for just about 
everybody in Massachusetts who needed coverage. When he decided to do 
this, he was smart enough to go back to Senator Chafee's blueprint from 
the 1993 legislation.
  It was a decade later that Mitt Romney became Governor. I say this as 
a recovering Governor myself: You are always looking for what works to 
see if it might be transferrable to your State. But he seized on 
Senator Chafee's proposal, and the similarities are pretty striking. 
Like the Chafee plan, RomneyCare--they call it RomneyCare--created 
these State exchanges, or purchasing pools, just as in Chafee's 
legislation. They had the sliding scale tax credits to help them buy 
coverage, buy their health insurance through the purchasing pool so 
people with a lower income could get a bigger tax credit, and as their 
income goes up, the credit gets smaller and smaller,

[[Page S1014]]

and then it finally phases out. That is what they did in RomneyCare.
  The third thing they had was a ban on preexisting conditions in 
Massachusetts. If someone had a preexisting condition, the insurance 
company could not say: No, no coverage for you. They had to provide 
coverage. Just like insurers told Senator Chafee all those years ago in 
1993; that if we are going to have to insure people because of 
preexisting conditions, you have to give us a pool of people to insure, 
that we can insure and not lose our shirts. That included individual 
mandates so we could have the young, the healthy in the pool, and at 
the same time call for the employer mandate so employers of a certain 
size had to ensure that their employees were getting health care 
coverage.

  That was in the Romney plan. They launched it about a decade ago, and 
right off the bat it was warmly embraced by the people of 
Massachusetts. They thought this could be cool. And it was good. It was 
the right thing to do. It might just work and be an example for the 
rest of the country. So they had a warm embrace and a good launch.
  In the first couple of years, they did a good job in RomneyCare in 
covering a lot of people and reducing the number of people who did not 
have coverage. What they didn't do such a good job on, though, for the 
first several years, was on the affordability side.
  Health care costs continued to rise in Massachusetts. There were 
several reasons for that, one of which was the individual mandate. They 
had a fine. So if you happen to be young and maybe you didn't think you 
needed health care, you had to pay a fine if you were a certain age and 
didn't sign up. It was an increasing fine that went up over time. 
Eventually, people decided, Well, if I have to pay this fine, I might 
as well get health care coverage, but they didn't do it initially. They 
were negative in terms of coverage.
  Eventually, in Massachusetts not only did they do a good job in 
increasing coverage, they actually did a pretty good job on 
affordability. One of the reasons is, they had a good mix of people in 
their pools and a fair amount of competition between health insurance 
companies and providers--competition.
  Fast forward to 2009, the Affordable Care Act. When the Affordable 
Care Act was reported out of committee to come here to the floor, what 
did it have? It had, No. 1, let's create these State large purchasing 
pools, State exchanges and marketplaces, and that is in Chafee's bill 
and in RomneyCare. It had sliding scale tax credits to help buy down 
the cost of coverage in the exchanges and marketplaces. There was a ban 
on preexisting conditions, but insurers said: No, we can't insure the 
people you want us to, we will have to cover everybody, and those who 
have preexisting conditions, you have to make sure we have a good mix 
of people in the insurance pool.
  So just like in Chafee and in RomneyCare, we had the individual 
mandate. You can't make people get coverage, but you can have an 
accelerating scale so people will eventually bite and get the coverage, 
and we also had the employer mandate. Not every employer but a certain 
size number of employers had to have--had to cover their employees.
  It is kind of remarkable. I think if you talked to most people in 
this country, and you walked through this, they would be amazed to know 
that the Affordable Care Act, with these five major provisions, was 
actually stolen, plagiarized, from a Republican Senator, Chafee, in 
1993; but from Governor Romney's proposal.
  There is more to the Affordable Care Act, including the expansion of 
Medicaid coverage--not for everybody, but up to 135 percent or so of 
poverty, and the real focus on how do we move from a sick care system, 
where we just spend money on health care for people who are sick, why 
don't we spend some money to try and make sure people stay well, on 
prevention and wellness, early access to care, so folks can get a 
colonoscopy maybe before they come down with colon cancer or get a 
mammogram before breast cancer, those kinds of things.
  One of the great things of the Affordable Care Act, little known to 
most people, is the idea that we need to collaborate in the delivery of 
health care so it is not just one hospital working by itself but maybe 
build a network of hospitals, and maybe with these, working with doctor 
groups, groups of doctors. The idea is to collaborate in the delivery 
of health care in ways that focus on wellness, prevention, and that is, 
I think, little noticed; the idea of better results for less money. I 
call it value, looking for value.
  That is just a little bit of history, and I think it is worth looking 
at.
  Could we look at the next one.
  I have a pie chart I would like to share with everybody. I don't know 
if the Presiding Officer has seen this before. I have used it once or 
twice. This is a pie chart that has about 300 million people in it, and 
this represents the 300 million or so people in our country who have 
health care coverage. The blue represents those folks who get their 
coverage through their employer. It doesn't mean the employer pays for 
all the costs of their health care; the employer pays the majority, and 
maybe the employees pay some fraction or percentage of that coverage. 
Over half the people in the country today getting health care coverage 
are those in large group plans. If you look at what is going on with 
premium increases, and increases in copays and deductibles, my 
understanding is the premium increases for these folks--over half of 
the 300 million people in the pool--we actually compared premium 
increases before the ACA was adopted and the years after, and premiums 
still go up for these folks but not by as much as they had before the 
Affordable Care Act was adopted.
  So that is how most people get their coverage here.
  Next, about--let's see, this green area right here, it has anywhere 
between 15 and 20 percent of people who get health care coverage in 
this country, they are in Medicare, the 65 and over or totally 
disabled, unable to work, and qualify for Medicare because of that. One 
of the little known things about the Affordable Care Act is that the 
Medicare trust fund had been running out of money for quite a while, 
and the date at which it eventually runs out of money and will not be 
able to provide coverage can continue to get closer and closer. One of 
the benefits, little known or noted in the Affordable Care Act, is that 
since it was adopted, the life of the Medicare trust fund has been 
extended by 12 years. After coming down for years and years and years, 
the life of the Medicare trust fund has been extended by 12 years. 
Medicare people, they don't buy their coverage on the exchanges, but a 
lot of people can still use fee-for-service. Maybe it works for some 
people. I don't know if it is the best way to get good coverage for an 
affordable price, but we have seen a migration to what is called 
Medicare Advantage. I think it is like managed care with a heart and a 
head, and now about one-third of the folks on Medicare get that 
coverage. Fifteen to twenty percent of the people get their coverage in 
this big 300 million-person pie chart from Medicare. About 20 to 25 
percent of the people who are getting health care coverage in the 
country today get their coverage through Medicaid. Believe it or not, 
it is not mostly part families or women with children, it is mostly 
people--maybe like our parents or grandparents who are in nursing 
homes, a lot of them with dementia. They spend down their resources and 
they end up going to nursing homes, and Medicaid pays to help keep them 
alive and cared for, and that is anywhere from 20 to 22 percent.
  The States previously--virtually every State has a Medicaid plan, but 
one of the things we did with the Affordable Care Act was to say we 
want to encourage States to cover not just up to 100 percent of poverty 
but maybe up to 135 percent of poverty. The Federal Government will pay 
about 90 percent of that, and maybe someday less than that, but we want 
more people to be covered through Medicaid, which is actually more 
cost-effective than the purchasing pools I talked about earlier.
  So we have 300 million people getting health care coverage. The 
lion's share of them--over 55 percent--get coverage from large group 
plans. About 22, 25 percent is Medicaid, about 15 to 20 percent 
Medicare, and what is left is about roughly 6 percent or so, they get 
their coverage through the exchanges, through the marketplaces.

  When our Republican friends and others criticize the marketplaces and 
the sliding scale tax credits and the individual mandates, the employer 
mandate, and maybe the ban on preexisting

[[Page S1015]]

conditions, what they are criticizing is right here, a very small 
portion of the pie, the heart and soul of what was proposed by Senator 
Chafee in 1993 and the heart and soul of what was in RomneyCare in 
Massachusetts a decade later. There is a certain irony there not lost 
on me and I know not on others.
  Can we do some things to improve the delivery of health care among 
all of these groups? Sure. Can we do it where it covers more people and 
does it in a more cost-effective way? Sure we can. But the idea of sort 
of getting rid of this--getting rid of particularly the piece down here 
and a lot of the other provisions that are represented in this pie 
chart, I don't think that makes a lot of sense.
  A friend of mine is a firefighter. We work out in Wilmington at the 
YMCA before I jump on a train and come to work. We were talking not 
long ago about a situation you have with a building that is on fire, 
and the people are up in the tall building and maybe can't get down to 
the elevators, and they rush to the windows to look out to see if there 
is anybody down there. The firefighters are outside the building that 
is on fire, and they are yelling with a bull horn up to the folks on 
the fourth and fifth floors: Go ahead and jump. We will catch you. But 
the people who are being asked to jump notice that the firefighters 
don't have any nets.
  The idea of health care coverage where we are actually covering a lot 
more people, and to say we are going to pull that away from you for 20 
million, 30 million more people, and don't worry, somewhere down the 
line--a year or 2 or 3 years from now--we will provide the nets to 
catch you, I think that makes no sense--no sense.
  We got this far, so maybe one more chart.
  Who gets hurt by repealing the Affordable Care Act?
  I will just say this and then close, I say to my friend from 
Maryland.
  The answer is everyone. We do not have a lot of rural space in 
Delaware. I know we have a lot in Louisiana and quite a bit in 
Maryland. But folks who get their coverage from the rural hospitals, 
whether it is in Delaware, Maryland, Delmarva, whether it is in 
Louisiana, the rural hospitals, they are going to get clobbered if we 
repeal the Affordable Care Act and take away the Medicaid expansion, 
take away the marketplaces. They will get clobbered and a lot of them 
will close. The federally qualified community health centers, they are 
going to get clobbered, and they provide coverage for 10 million people 
in our country.
  When people are denied coverage in those rural hospitals or suburban, 
urban hospitals or the federally qualified community health centers, 
where people don't get coverage there, they will get health care 
somewhere, and it may be going to an emergency room at a hospital, 
getting really sick and having to get admitted and then spend a lot of 
money. Where does the money come from? From those of us who use the 
health care system, who are paying premiums and our employers are 
paying premiums. The costs are really absorbed by the hospitals 
themselves. It makes not a lot of sense.
  The person in the House who has been really in the forefront of 
repealing the Affordable Care Act is the person that Donald Trump has 
now named to be our Secretary of Health and Human Services. The idea of 
having a new Secretary overseeing the Department of Health and Human 
Services, someone who is trying to run this program and oversee it and 
make sure that it works in a way that provides more coverage at an 
affordable price, is actually a person who has been trying to kill it 
for as long as he has been in the House of Representatives. Some people 
may not be concerned or upset about that, but I am. I think that before 
we put that person in charge in that job, we need to remember some of 
the lessons I just shared with folks here today. For these reasons, I 
cannot support the nomination.
  With that, I yield the floor.
  The PRESIDING OFFICER. The Senator from Maryland.
  Mr. VAN HOLLEN. Mr. President, I thank my friend and colleague from 
Maryland's neighboring State of Delaware, the senior Senator, Mr. 
Carper. I thank him for raising those points about the very negative 
impact that repealing the Affordable Care Act would have on so many 
folks in Delaware and Maryland and, specifically, rural hospitals. The 
Eastern Shore of Maryland and the Delmarva Peninsula have lots of rural 
hospitals that will be put in the crosshairs if we repeal the 
Affordable Care Act, so I thank the Senator for raising those issues 
and sharing with the Senate the impact of what repeal would do.
  I rise to oppose the nomination of Tom Price to be Secretary of the 
Department of Health and Human Services. I am very familiar with the 
views and the policy positions of Congressman Price and the ideas he 
has with respect to health care and budget issues facing our Nation.
  Before coming to the Senate, I served as the senior Democrat, the 
ranking member on the House Budget Committee, and Congressman Price is 
the chairman of that committee. I have said this before, and I say it 
again; that despite our very deep differences over critical issues 
facing our country and health care policies, Representative Price did 
conduct the business of the Budget Committee in a professional manner.
  I respect the intensity with which he argues his case, but it is 
because of his inflexible and highly ideological positions on critical 
matters before us that I oppose him. I firmly believe his policies will 
do great harm to the health and well-being of tens of millions of 
Americans throughout this country. That is why I oppose his nomination 
for this very sensitive post.
  During the Presidential campaign, Candidate Trump tweeted, ``I was 
the first and only potential GOP candidate to state that there will be 
no cuts to Social Security, Medicare and Medicaid.'' President Trump 
has repeated those promises since then.
  Yet, throughout his tenure in the Congress and throughout his time as 
chairman of the House Budget Committee, Representative Price has taken 
the exact opposite position, calling for cuts to Medicare, cuts to 
Medicaid, cuts to Social Security. He is now going to be overseeing the 
Department responsible for Medicare and Medicaid. So let's look at how 
Chairman Price's policies would impact those programs and harm the 
health care of Americans.
  First, on Medicare, he has called for privatizing Medicare through a 
voucher program. Make no mistake--seniors on Medicare are going to pay 
a lot more under their voucher plan.
  Here is how it works: Instead of going to the hospital and having 
Medicare cover the costs, seniors will instead get the equivalent of a 
voucher. Here is the catch: The value of that voucher will not rise 
nearly as fast as the cost of health care in this country, so each year 
that goes by, the value of that voucher will pay for less and less 
health care for seniors on Medicare.
  Yes, Tom Price's plan saves Medicare money. It saves Medicare money 
by requiring senior citizens on Medicare to eat the difference--the 
difference between the value of the voucher, which is effectively 
frozen over time, and the cost of health care that those seniors are 
going to need. That is the wrong approach for making savings in 
Medicare.
  The right approach is the approach taken in the Affordable Care Act, 
where we begin to change the incentives in the system, so we encourage 
doctors and hospitals to focus on the value of care they provide, not 
the volume of care they provide.
  Another way in which Representative Price, the President's nominee, 
would harm seniors on Medicare is when you repeal the Affordable Care 
Act, you reopen what was called the prescription drug doughnut hole. 
One of the things the Affordable Care Act did was allow seniors with 
high prescription drug costs to not have to choose between paying the 
rent or putting food on the table and the cost of their drugs. Over 
time, it is closing that doughnut hole that seniors fell into and 
couldn't cover the costs of needed prescriptions. When you repeal the 
Affordable Care Act, you repeal those protections for seniors. That is 
what Tom Price's budget would do. It is right there in his budget plan.
  Another harm that would befall seniors is that repealing the 
Affordable Care Act wipes out the provision that allows seniors on 
Medicare to get free preventive screenings. We want to encourage 
seniors, just like everybody

[[Page S1016]]

else, to catch health problems early, so we said: You don't have to pay 
these steep copays if you want to get screened for cancer, diabetes, or 
whatever it may be. Millions of seniors have now benefited from that--
not only by not having to pay out of pocket but by catching problems 
early and getting them treated so they get the health care they want. 
But Tom Price's plan would repeal all of that.
  If you are a senior on Medicare now or a senior who may be getting to 
the point of Medicare or anybody else--we are all going to be there 
someday--No. 1, you are going to see the plan turn into a voucher plan, 
which is going to cost a lot more for no more health care, maybe less; 
you are going to pay more for prescription drugs; and you are going to 
pay more for preventive screenings. That is a bad deal, but that is the 
Tom Price plan.
  Let's take a look at his Medicaid proposal. Again, Candidate Trump 
said he wasn't going to cut Medicaid. The budget plan put forward by 
Tom Price, chairman of the House Budget Committee, calls for over $1 
trillion in cuts to Medicaid over 10 years. It is right there in the 
plan. Just read it. They don't make any secret about it. The 
accompanying report talks about it--$1 trillion over 10 years.
  Many people don't realize this, but two-thirds of the money we spend 
for Medicaid goes to provide long-term care to seniors in nursing 
homes, to people with severe disabilities, very fragile individuals who 
have no other source of medical security. It would cut dramatically 
from that. Almost 50 percent--the largest single share of people in 
Medicaid--is kids. They are kids.
  I just happened to meet today with the head of the Children's 
National Health System and his team. His No. 1 plea and request to me: 
Don't cut Medicaid. You will hurt kids if you do it.
  They provided me some information and facts. What is Medicaid? 
Medicaid is the single largest health insurer for children. Medicaid is 
a vital program for children. It covers over 30 million children 
nationwide. When we cut Medicaid by $1 trillion, we hurt children by 
hurting their health care.
  In addition to calling for these very deep and damaging cuts to 
Medicaid, harming the Medicare program, and raising the costs to 
seniors, Representative Tom Price has been one of the fiercest 
opponents of the Affordable Care Act, wanting to wipe it out. We hear a 
lot about replacement. In other words, the mantra has been, let's 
repeal it and replace it. In fact, President Trump, both as candidate 
and now, says he is going to replace it with something much better. 
Much better. We heard for years Republicans in the House and the Senate 
saying they were going to replace it too. We have heard them say that 
since the Affordable Care Act was first put in place roughly 7 years 
ago: Repeal and replace. But as we are gathered here today, there is 
absolutely no replace.
  But they did repeal. A lot of people don't realize they repealed it 
because President Obama was there to veto the legislation that came to 
his desk that repealed the Affordable Care Act. But it was just last 
year. Congressman Tom Price--the person who is going to be in charge, 
if President Trump has his way, the head of HHS--was the main architect 
of that repeal--not repeal and replace; repeal.
  The nonpartisan Congressional Budget Office--the organization the 
Congress relies on to present unbiased analysis--in fact, the current 
Director of CBO was selected by the Republican chairman of the House 
committee and the Republican chairman of the Senate committee. They 
issued a report just last month, January 2017. What would have happened 
if Tom Price's repeal had actually been signed by President Obama? What 
if that had actually become law? What would have happened to health 
care in America? Here is what they said: The number of people who are 
uninsured would increase by 18 million in the first plan year following 
enactment of the bill. Later, after the elimination of the Affordable 
Care Act's expansion of Medicaid eligibility and subsidies, that number 
will rise to 32 million in 2026. So in year 1, 18 million Americans 
would lose access to health insurance.
  How about the cost of premiums? The cost of premiums in the exchanges 
have been high, and there are practical things we can do to reduce 
them. But if Tom Price had his way, according to the Congressional 
Budget Office, here is what would have happened: Premiums in the non-
group market, the Affordable Care Act exchanges, would increase by 20 
percent to 25 percent relative to current law--in other words, compared 
to if we did nothing.
  It is really important that the American public understand that the 
man the President is asking to be head of Health and Human Services for 
the United States of America is the same person who was the architect 
of the bill that went to President Obama that within its first year 
would have resulted in 18 million Americans losing access to health 
care and jacking up premiums by 20, 25 percent in the exchanges. That 
is what would have happened. Thank goodness President Obama was there 
to veto that legislation. But he is not there anymore, and President 
Trump is installing the person who would have had the dramatic negative 
impact on the health care of millions of Americans--your constituents, 
my constituents--and all of us have heard many stories about the 
impact.
  I will close where Senator Carper closed because he went through many 
examples of who was going to be harmfully impacted by getting rid of 
the Affordable Care Act. When we add it all up, it is just about 
everybody.
  In addition to the 22 million Americans on the health care exchanges 
who will lose that access entirely, Americans who get their health care 
through their employers--which is most of them--benefit from the 
patient protections in that legislation. Frankly, they benefit from the 
fact that people who used to not be able to get any health care and who 
were showing up in the emergency room and raising the costs for 
everybody else--they will have it, which is why, as he said, premiums 
for the majority of Americans in the employer market have actually gone 
up very slowly compared to what they were doing before the Affordable 
Care Act. As I mentioned, seniors on Medicare get socked in the chin.
  I just came from a meeting with the head of one of Maryland's rural 
hospitals in Western Maryland, out on the Maryland panhandle. This is 
an area that Donald Trump carried overwhelmingly with a big vote out in 
Western Maryland.
  The CEO of Garrett Regional Medical Center came to my office today 
and let me know all the good things they are doing for people in 
Western Maryland. The last page of this request says: ``Seeking your 
support,'' and here is the bullet point: Garrett Regional Medical 
Center is very concerned about ACA repeal. Our organization will 
implode--implode--without proper replacement.
  Yet the legislation, the reconciliation bill that Representative Tom 
Price rammed through the House and then they got through the Senate and 
went to President Obama's desk, would have done exactly that--it would 
have imploded this Western Maryland regional medical center. Imploded 
it. President Obama said no.
  Now, despite the fact that Candidate Trump tweeted out that he wanted 
to protect Medicaid and Medicare, he has appointed somebody to this key 
position who has taken the opposite position. That is why I cannot in 
good conscience vote in support of this nomination. It is too big a 
risk to the health care of Marylanders and to the American people.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Maryland.
  Mr. CARDIN. Mr. President, first let me comment and thank my 
colleague from Maryland, Senator Van Hollen. Senator Van Hollen may be 
a new Member to the U.S. Senate, but he is not a new Member to the 
Congress of the United States.
  I think Senator Van Hollen said this very clearly: This nomination is 
very much about the type of health care system we want for the people 
in this country, whether we are going to have affordable, quality 
health care for all Americans, whether health care is going to be a 
right or a privilege. I thank Senator Van Hollen for the points he 
made.
  I think the people of Maryland are not going to be surprised that I 
agree with my colleague from Maryland and that I take this time to 
explain why I will oppose Mr. Price for Secretary of Health and Human 
Services.

[[Page S1017]]

  Let me begin by talking about something that happened in Maryland 
during my first year in the U.S. Senate. I was elected in 2006. In 
2007, in my very first year, we had a tragic situation that occurred a 
few miles from where we are right here, in Prince George's County, MD. 
A youngster, 12 years of age, Deamonte Driver, died from a tooth 
problem. Let me give you the background on this because this is a very 
tragic situation. This is in the State of Maryland, one of the 
wealthiest States in one of the wealthiest nations.
  Deamonte Driver's mother recognized that Deamonte Driver had pain in 
his mouth. She tried to get him to a dentist, but they had no insurance 
and no coverage. She couldn't get anyone to take care of her son. What 
was needed was an $80 tooth extraction. If he could have seen a 
dentist, that is exactly what would have happened. He couldn't get in 
because he had no insurance, and he fell through the cracks of our 
system. That tooth became abscessed, and it went into his brain. He 
went through two operations, hundreds of thousands of dollars of cost, 
and he lost his life.
  That happened in my first year in the U.S. Senate. I vowed to do 
everything I could to make sure there were no more tragedies anywhere 
in America like Deamonte Driver's. Every child should be able to get 
access to oral health care. It is who we are as a nation. It is part of 
who we are, and it makes sense from the point of view of an efficient 
health care system.
  I introduced legislation to provide pediatric dental care in this 
country. I worked with my colleague Elijah Cummings in the House of 
Representatives and with others here, and we were able to make some 
progress. Ultimately, we were able to get this as part of our national 
health policy in the Affordable Care Act. It is now part of what is 
known as essential health services.
  I start this debate on the floor of the U.S. Senate by saying that 
Dr. Price, the nominee for Secretary of Health and Human Services, is 
one of the leaders for the repeal of the Affordable Care Act, which 
would repeal essential health services, which would eliminate the right 
for all children in America to have pediatric dental care. So I then 
look at what Mr. Price would replace it with, and I am confused because 
I am not exactly sure what he would replace it with. I have looked at 
what he has done as a Member of the House, I have looked at what he has 
done as the chairman of the Budget Committee, and I am not confident 
that we would maintain that type of guaranteed coverage for our 
children.
  That is just one concrete example--one person--of why I am concerned 
about what would happen if we repealed the Affordable Care Act, and we 
don't know what is coming next.
  The Affordable Care Act--30 million Americans now have affordable, 
quality health care as a result of the Affordable Care Act. The repeal 
of that law would jeopardize those 30 million. In Maryland, the 
uninsured rate has gone down from over 12 percent to a little over 6 
percent. We have cut our uninsured rate by about 50 percent. That is so 
important for so many different reasons. Yes, it is important for the 
400,000 Marylanders who now have third-party coverage who didn't have 
third-party coverage before. They now can go see a doctor rather than 
using an emergency room. They don't have to wait if they have a medical 
condition; they can get care immediately. They can get access to 
preventive health care that keeps them healthy so they don't enter our 
health care system in a much more costly way.
  Before the Affordable Care Act, these 400,000 people got their health 
care, but they didn't get it in the most cost-effective way. They used 
emergency rooms, which are very expensive. They didn't pay for their 
bills. They entered the health care system in a more acute way, using 
more health care services than they need, and they didn't pay their 
bills. As a result, we saw that those who had health insurance were 
paying more than they should because of those who did not have health 
insurance. That added to the cost, not just of those who didn't have 
the insurance but to all Maryland insured.
  Mr. President, I see that the distinguished majority leader is on the 
floor. I will be glad to yield to him. I believe he has an announcement 
he wants to make.
  The PRESIDING OFFICER (Mr. Blunt). The majority leader.

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