[Congressional Record Volume 163, Number 27 (Wednesday, February 15, 2017)]
[Senate]
[Pages S1192-S1197]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
Repealing and Replacing ObamaCare
Mr. President, I want to once again discuss the ongoing effort to
repeal and replace the so-called Affordable Care Act. This is one of
our most vexing issues of the day. Of course, this isn't the first time
I have come to the floor to discuss ObamaCare, and I am fairly certain
it won't be the last.
I was here just last week, in fact, talking about the general
unanimity among Republicans on these issues, despite the seemingly
eternal focus on the supposed divisions among our ranks. While some are
still advancing that narrative, Republicans are, overall, still united
in our desire to repeal and replace ObamaCare. As I said last week, I
don't know if there is a single Republican in Congress who supports
keeping the healthcare status quo in place. All of us want to right
what went wrong with the poorly named Affordable Care Act and provide
patients and consumers with more healthcare choices that address
healthcare costs.
Most differences of opinion that do exist on these matters are more
about timing than anything else. As I have said before, I support
moving quickly to repeal ObamaCare and include as many replacement
policies as possible under the rules of the reconciliation process.
More specifically, I support repealing ObamaCare's harmful taxes, and I
will explain why.
Put simply, the tax provisions in ObamaCare were poorly conceived and
recklessly enacted, and they are harmful to our economy. Those taxes
came in a number of forms, including the employer mandate and the
individual mandate, both of which are enforced through the Tax Code.
In addition, there is the health insurance tax, the Cadillac tax,
along with new taxes on healthcare savings and pharmaceuticals.
ObamaCare also included a payroll tax hike for some high-income earners
as well as additional taxes on investing. And, of course, we cannot
forget the medical device tax, which, in just the first 3 years that
ObamaCare was implemented, resulted in more than 30,000 lost jobs in
that important industry.
All told, the tax provisions of the Affordable Care Act represented a
trillion-dollar hit on the U.S. economy in the first 10 years, and the
burdens of the vast majority of these taxes are ultimately borne by
patients and consumers in the form of higher costs, larger tax bills,
and reduced value in existing health plans and savings accounts.
I know some of my colleagues like to plead ignorance on the notion
that taxes on a particular industry tend to be passed along to that
industry's consumers, but it is a fact that can't be ignored. Taxes on
health insurance plans increase premiums for patients. Taxes on drug
companies make drugs more expensive. Taxes on medical device sales
increase the costs of those devices.
It is not a complicated concept; it is the natural byproduct of tax
provisions negotiated with stakeholders behind closed doors under
threat of increased government intrusion and market regulation. These
taxes weren't drafted solely to pay the cost of ObamaCare; they were
also part of a strategy to get the law through Congress, dividing the
business community and pitting industries against one another to
prevent widespread opposition. As I said, at the end of the day, it is
patients and consumers--individuals and families--who pay most of the
freight on these types of tax policies.
Don't take my word for it. Let's look at one major example.
Congress's nonpartisan scorekeeper, the Joint Committee on Taxation,
indicated that, by and large, the tax on health insurance premiums
would be passed along to health insurance policyholders.
Mr. President, I ask unanimous consent to have printed in the Record
a letter from the JCT to Senator Grassley, dated October 28, 2009.
There being no objection, the material was ordered to be printed in
the Record, as follows:
Congress of the United States,
Joint Committee on Taxation,
Washington, DC, October 28, 2009.
Hon. Charles E. Grassley,
Ranking Member, Committee on Finance, U.S. Senate,
Washington, DC.
Dear Ranking Member Grassley: You requested that we provide
you with an analysis of the incidence of the insurance
industry fee provision of S. 1796, the ``America's Healthy
Future Act,'' our estimate of the effect on the after-tax
price of purchased health insurance, and a distributional
analysis of the provision.
insurance industry fee
Sec. 6010 of S. 1796 would impose an annual fee on any
covered entity engaged in the business of providing health
insurance with respect to United States health risks. Under
the provision, employers who self-insure their employees'
health risks and governmental entities are not covered
entities.
The fee applies for calendar years beginning after 2009.
The aggregate annual fee for all covered entities is $6.7
billion. Under the provision, the aggregate fee is
apportioned among the covered entities based on a ratio
designed to reflect theft relative market share of U.S.
health business.
For each covered entity, the fee for a calendar year is an
amount that bears the same
[[Page S1193]]
ratio to $6.7 billion as (1) the covered entity's net
premiums written during the preceding calendar year with
respect to health insurance for any United States health
risk, bears to (2) the aggregate net premiums written of all
covered entities during such preceding calendar year with
respect to such health insurance.
incidence of insurance excise taxes
The proposed fee is similar to an excise tax based on the
sales price of health insurance contracts. The effective
excise tax rate varies from year to year depending upon the
aggregate value of health insurance sold. The economic
incidence of an excise tax imposed on sale of health
insurance contracts (that is, who actually bears the cost of
the tax) may differ from the statutory incidence of the tax
(that is, the person on whom the tax is levied). Taxes may be
borne by any of the following: consumers in the form of
higher prices; owners of firms in the form of lower profits;
employees in the form of lower wages; or other suppliers to
firms in the form of lower payments. This makes
generalizations about the incidence of taxes difficult to
make. Nonetheless, two principles have general validity.
First, economic incidence does not depend on whom the tax is
levied. Whether the statutory incidence of the tax is on the
consumer, the employer, or the insurer, the economic
incidence is the same regardless of who writes the check to
the government. Second, taxes are shifted from those who are
more sensitive to price changes (economists describe these
individuals and entities as having more ``elastic'' supply
and demand) to those who are less sensitive to price changes
(those with more ``inelastic'' supply and demand).
In the case of competitive markets, an excise tax generally
is borne entirely by consumers in the form of higher prices
in the long term. An excise tax increases the cost of
producing an additional unit, or incremental cost, of the
taxed good by the amount of the tax. In a competitive market,
market forces cause the after-tax price of a good to equal
the additional cost of producing and selling another unit of
the good. Competition drives the price down to equal the
incremental cost of the provision of the good or service,
including the return to incremental invested capital. If
supply is perfectly responsive to price changes, any price
above incremental cost would induce new firms to enter and
increase production until prices were bid back down to
incremental cost. Similarly, any price below incremental cost
would induce firms to exit or reduce production (because they
would now be losing money selling the taxed good). The
reduction in supply allows prices to increase back up to
incremental cost.
This response may be observed even if some of the
participants in the competitive market do not seek to
maximize profits as their primary objective. Tax-exempt and
nonprofit producers may also pass on the tax as they also
face the increased incremental cost, which they will need to
recover. If they cannot, for example, raise additional funds
from donors, effectively passing the tax on to them, their
alternative is to pass on the tax to consumers in the form of
higher prices.
While consumers are thought to bear the burden of excise
taxes in competitive markets, some may question the degree of
competition in health insurance markets. Recent surveys have
noted that many markets are characterized by the presence of
only a few firms. Additionally, there may exist barriers to
entry in the health insurance market, including multiple
State regulatory requirements, the cost of establishing
health provider networks, health provider network effects
(i.e., the value of a health provider network to consumers
rises with the size of the network), and efficiencies in
risk shifting and risk distribution for large firms.
However, the absence of many competitors does not by itself
imply that there is no competitive pressure on prices. The
threat of potential entrants may provide competitive price
pressure on the existing firms. Furthermore, the option to
self-insure may provide a source of potential competition for
full, purchased insurance, at least for larger firms.
If the insurance industry is not perfectly competitive in a
particular market, the question remains as to what extent an
insurance excise tax would be borne by consumers or producers
in that market. Theoretical analysis has shown that,
depending upon market conditions, the price could increase
by: (1) more than the amount of the tax; (2) exactly the
amount of the tax; or (3) less than the amount of the tax.
Various empirical studies have examined the effect of excise
taxes on prices in less than perfectly competitive markets.
Studies of the tobacco industry suggest that manufacturers
pass on more than the full amount of the tax, while studies
of less than perfectly competitive retail gasoline markets in
rural areas suggest that producers pass on nearly all of the
tax. Even in the rural retail gasoline markets in which gas
stations may be the sole provider of gasoline for many miles
and firms exhibit some pricing power, nearly 95 percent of
the excise tax is still passed on to consumers.
While uncertainty exists, we assume that a very large
portion of the excise tax on purchased insurance will be
borne by consumers in most markets, including in some markets
with a high level of concentration among market participants
covered by the proposed excise tax. In the context of general
health care reform legislation, this assumption is further
supported by the presence of an excise tax on individuals
without minimum essential benefits coverage, which is likely
to make demand for insurance somewhat less sensitive to
changes in price, as consumers will have to buy insurance or
face a penalty. While consumers (or employers) may respond by
changing their insurance coverage from more expensive
coverage to less expensive plans to offset any potential
price increase, this behavior too is properly characterized
as the consumers bearing the burden of the excise tax by
accepting lower quality (for example, a more restricted
physician network) for the same price rather than paying a
higher price for the quality of insurance that they would
prefer if there were no tax. To the extent that firms can
avoid the tax by switching from full insurance to self-
insurance, this may suggest that insurers are unable to pass
on the full cost of the excise tax on purchased insurance.
Increased self-insurance from firms avoiding the excise tax
may increase the cost of this health benefit to employees as
firms that previously chose full insurance, presumably
because it cost less in the absence of the excise tax than
self-insurance, switch to higher cost self-insurance.
Additionally, to the extent that insurers maintain some
pricing power in the administrative services that they
provide self-insurers, the self-insurance market may bear
some of the burden of the excise tax as well.
effect of the fee on the cost of purchased health insurance
The aggregate value of the proposed fee is the same for
each year. The current law baseline for health insurance
premiums projects rising health insurance premiums annually
through the budget period. Consequently the magnitude of the
proposed fee declines annually relative to the sale of health
insurance. Given the incidence analysis discussed above,
while there is imcertainty, we expect a very large portion of
proposed insurance industry fee to be borne by purchasers of
insurance in the form of higher premiums. Our estimate is
that the premiums for purchased health insurance policies,
including the tax liability, would be between 1.0 and 1.5
percent greater than they otherwise would be as a consequence
of the industry fee for calendar years 2010, 2011, and 2012.
distributional analysis of the insurance industry fee
Regardless of the determination of the economic incidence
of the proposed insurance industry fee of S. 1796, at the
present time the staff of the Joint Committee on Taxation is
not able to distribute the effects across individuals on our
individual tax model. The proposed insurance industry fee
would apply only to the revenues from underwritten policies
sold to third parties. It would not apply to the value of
health benefits received by individuals through their
employers who self-insure the health risks of their
employees. Our individual tax model is based upon a sample of
approximately 180,000 actual tax returns. To distribute
proposed tax changes related to economic activity that is not
already reflected on the individual tax return we impute
values or statistically match supplemental information such
as data gathered by the Census Bureau, to the individual tax
returns of our model. For our quantitative analysis of
employer-provided health benefits we have made such
imputations of data relating to employees' employer-provided
health care benefits to the individual model. These
imputations are based on the data collected as part the
Medical Expenditure Panel Survey (``MEPS''), a survey
undertaken by the Agency for Healthcare Research and Quality
of the Department of Health and Human Services, However, the
imputations we have made to the individual tax model at this
time relate only to the value of employer expenditures for
the health care of their employees. These imputations do not
generally distinguish between the employers' purchased
insurance coverage and benefits for which the employer self-
insures. Consequently, we are unable to distribute either the
economic incidence or the revenues generated from the
proposed fee of S. 1796, which applies only to purchased
health insurance,
I hope this information is helpful to you. Please contact
me if we can be of further assistance,
Sincerely,
Thomas A. Barthold.
Mr. HATCH. While we are setting the record straight on ObamaCare, my
colleagues on the other side have repeated a particular false claim
that needs correction. My Democrat friends are fond of characterizing
the repeal of ObamaCare as a tax cut for high-income earners and a tax
increase for low- and middle-income taxpayers. That claim is simply
false.
According to JCT, the Joint Committee on Taxation, the Affordable
Care Act imposed significant and widespread tax increases on taxpayers
earning less than $200,000 a year, despite President Obama's repeated
promises that the law would not do so. In fact, in 2017, a single
provision--the reduction in the deductibility of catastrophic losses--
is projected to raise taxes on 13.8 million taxpaying families and
individuals, mostly from the middle class. That is more than the number
of taxpayers who receive exchange credits and other premium subsidies
under
[[Page S1194]]
current law. That is just one example. There are others.
Fortunately, we have been able to forestall the impact of a number of
the ObamaCare tax provisions. We have fought and negotiated long and
hard to do so, but virtually all of those taxes are still looming on
the ObamaCare horizon.
Most of us on the Republican side have been fighting these taxes more
or less since the day ObamaCare was signed into law. We have
highlighted their harmful impact on the economy and decried the crony
capitalism that was behind the effort to draft and enact them.
Given this long history, at least in my view, it is essential that we
repeal all of these taxes, along with the rest of ObamaCare. It is
difficult to imagine how Republicans, who are now in the majority in
large part due to the promises we made to repeal and replace the
Affordable Care Act, can now sift through ObamaCare's taxes and decide
which ones are the least objectionable so that we can use them to pay
for our own healthcare reforms.
ObamaCare isn't problematic simply because healthcare costs are not
going up; it was fundamentally flawed at the outset. The way the law
was drafted was, and still is, a problem. The way the law was
negotiated--with stakeholders being played against each other--was, and
still is, a problem. Of course, the way the law was paid for was, and
still is, a problem. The ObamaCare taxes are a big part of this
equation. In my view--and, I think, the view of the vast majority of my
Republican colleagues--they have to go.
As I said, there really are not widespread disagreements among
Republicans on these issues. Overall, we broadly agree on the
fundamental issues surrounding ObamaCare, and, as I noted last week, it
is not all that problematic to have some differences of opinion on the
initial stage, so long as we can overcome those differences in the end.
I think we can do that. More importantly, I think we will.
Mr. President, I yield the floor.
The PRESIDING OFFICER (Mr. Lee). The Senator from Illinois.
Mr. DURBIN. Mr. President, pending before the U.S. Senate is the
nomination of Mick Mulvaney, a Congressman who is seeking to be the
Director of the Office of Management and Budget.
If you were to ask the people of America about the Cabinet positions
filled by the President, the one they probably would miss is the Office
of Management and Budget. It turns out to be one of the more important
positions, but it is not as well known historically as Treasury
Secretary, Secretary of State, and Attorney General. It is an important
job. It is one of the most consequential jobs because the Director of
the Office of Management and Budget is responsible for preparing the
President's budget, setting the priorities of the Federal budget, and
overseeing the performance of Federal agencies. It is a big and
challenging job.
Many other nominees for positions in the Cabinet are well known and
have been debated on the floor of the Senate. Today I come to say a few
words about the record of this Congressman, Mick Mulvaney, who is
seeking this directorship of the Office of Management and Budget. It is
a very interesting record.
It is not unusual for Members of the House and the Senate to have
unusual positions on issues. I guess each one of us has something we
believe intensely that other people question. When it comes to
Congressman Mulvaney, there is a long litany of positions he has taken
that are far out of the mainstream of either political party. Yet
President Donald Trump decided this is the man, this is the person he
wanted to head up his budgeting effort. This is the person he wants to
set the priorities for spending in the United States of America during
his Presidency.
If you look at the record of Mick Mulvaney, you will find that he has
had an eagerness to dictate large and draconian cuts across the Federal
Government in some of our most important and most cherished programs.
Let me tell you about a few that highlight his record in Congress. Each
one of these that I will speak to, if advanced by the Director of the
Office of Management and Budget, would have far-reaching consequences
on families and individuals across the United States, not only in the
operation of government but also in the effectiveness of our Federal
workforce.
To start with--and this, I think, is the right place to start--
Congressman Mulvaney, who seeks the position of Director of the Office
Management and Budget, has repeatedly led efforts to shut down the
Federal Government. When Mr. Mulvaney and the Republicans succeeded in
shutting down the government for 16 days in 2013, it cost the American
economy $20 billion. Do you remember that?
Rush Limbaugh got on his radio show and said: If they shut down the
government, no one will even notice.
Guess what, Mr. Limbaugh. They noticed.
All across America, working families paid the price for that foolish
political act of shutting down the government. The real cost of the
government shutdown is not just measured in dollars. The real cost is
in hardships unnecessarily created, hardships for Federal employees who
didn't receive their checks on a timely basis, hardships for people
struggling to survive in America, who relied on programs like food
stamps. We call them SNAP benefits now. They had their food in jeopardy
and endangered because Congressman Mulvaney and his friends thought
that a display of political power--shutting down the government--was
the right recipe for America.
These government shutdowns delayed 2 million Federal workers from
receiving their checks, real people with real families to feed.
Congressman Mulvaney doesn't seem to care about these real-world
consequences of a shutdown. Instead, he called the shutdown of the
Federal Government ``good policy.'' Those are his words: ``good
policy.''
Then, when we finally reached an agreement to reopen the government,
he was one of the few Members of the House to vote against the
compromise in reopening the government.
In recent years, he has repeated his calls. He is willing to shut
down the government of the United States of America to defund Planned
Parenthood. This man wants to craft our national budget, and he would
shut down the government over one provision in that budget? That is
what he said.
Time and again, he has taken extreme positions on the Federal budget.
We have a standing tradition in the House and the Senate. Since not one
of us can predict when the next natural disaster is going to occur, we
try to help one another.
I have voted for funds during the course of my congressional career
for disasters in probably every State in the union. Do you know why?
Because I knew the day would come--and it did, several times during my
tenure in the House and Senate--when there would be a natural disaster
in my State, and we needed a helping hand, emergency disaster
assistance. That is a tradition which has been around Congress--I can
go back almost centuries to see it in past history.
Listen to what Congressman Mulvaney did. He tried to block emergency
disaster assistance to States that desperately needed the help of the
Federal Government in their recovery efforts. He offered a poison pill
amendment to the Hurricane Sandy relief package that would have
required across-the-board cuts in military spending--military
spending--to pay for disaster relief from Hurricane Sandy. Then he went
further and said: Not just military spending, I want cuts in
entitlement programs--Medicare, Medicaid. Let's cut the healthcare
assistance for Americans to pay for that disaster. That is his idea of
social justice.
Despite President Trump's campaign promises to rebuild the Nation's
crumbling infrastructure, Congressman Mick Mulvaney has taken an
extraordinary and extreme view. He wants to eliminate Federal funding
for transportation projects. He cosponsored a bill that would slash the
Federal gas tax. That is how we pay for repairing Federal roads and
mass transit across America. He isn't interested in fixing the highway
trust fund solvency problems. His solution is to bankrupt it.
This is the man who wants to write the budget for America? His
extreme ideology would threaten billions of dollars that my State
receives in Federal transportation funds. We put money into the Federal
highway trust fund,
[[Page S1195]]
too, every time we buy a gallon of gas in Illinois. He would cut back
on the resources coming back to my State and others to repair the very
roads we drive on.
He has consistently supported across-the-board cuts for the
Department of Defense, regardless of those affected. Just a few minutes
ago, Senator John McCain, the senior Senator from Arizona, came to the
floor to announce that because of Congressman Mulvaney's positions on
cuts in the military, he--Senator McCain--would oppose the appointment
of Mulvaney as head of OMB. Senator McCain said that it is a rare day
when he comes out against a Presidential nominee of his own party. But
he thinks Mulvaney's record is worrisome, and I couldn't agree
more. The positions that Congressman Mulvaney has taken are reckless
and would jeopardize the economic security of working families and put
our Nation and economy at risk.
Possibly one of the most troubling positions that Congressman
Mulvaney has taken is the fact that he is opposed to the Federal
Government spending funds for medical research. Last year when Congress
was deliberating how to combat the Zika virus, Representative Mulvaney
wrote this on his Facebook page: ``Do we really need government-funded
research at all?''
Let's think about that for a moment. Do we really need government-
funded medical research in the United States? Do we need the National
Institutes of Health, the Department of Defense, and the Veterans'
Administration investing in trying to find new cures for diseases?
Government-funded research in the Department of Defense has produced
fascinating insights into the biology of breast cancer that have
greatly impacted the treatment of that disease and saved lives in
America. Look at the revolutionary Department of Defense-funded work
that led to the development of the innovative drug Herceptin.
Government-funded research, which Congressman Mulvaney does not believe
we should do, at the National Institutes of Health has accomplished the
following. It has cut the U.S. cancer death rate by 11 percent in women
and 19 percent in men. And Congressman Mulvaney says: Do we really need
to do that? Is that important? I would guess that his family, like
every family in America, has a story to tell about cancer--what it has
meant, the devastation it has created, the deaths that have resulted.
But Congressman Mulvaney doesn't get it. He just doesn't understand
anything as basic as investing in medical research to save lives. HIV/
AIDS is no longer a death sentence in America. I saw Magic Johnson just
a few weeks ago at a farewell party for President Obama. I remembered
the day in the House of Representatives when I was told that he had
AIDS. We assumed he would die in just a short period of time. But that
was over 25 years ago. He has survived because of research that was
done at the National Institutes of Health, and he is not alone. There
are thousands just like him.
When I was a kid, polio was something every mother and father were
frightened of. What in the world was happening? How could your child be
infected with polio and end up being crippled for life? Our Republican
leader here, Mitch McConnell, went through that in his childhood and
has talked about that episode in his life and how devastating it was.
He has had a full life since then, but he has overcome the problems of
that disease. I remember as a kid in grade school, when they announced
that our government research had come up with a vaccine that would
protect kids from polio. That, to me, was a breakthrough, and one that
I welcomed and our family welcomed.
Congressman Mulvaney questions whether or not medical research should
continue, even in the light of the achievements in eradicating polio
and small pox and other diseases in our country. These advances didn't
just magically happen because of the miracle of the marketplace. They
occurred because of sustained taxpayer investment in Federal medical
research.
I will tell you this. If he wants to make a referendum in the Senate
or the House on medical research a part of his budget debate, I welcome
the challenge. I believe that Members of both political parties would
stand up for medical research, despite Congressman Mulvaney's extreme
positions.
So when someone asks if we really need government-funded medical
research, the answer on behalf of cancer patients who are beating the
disease, on behalf of HIV/AIDS patients who are living longer and
normal lives, on behalf of all those families hoping and praying that
some Federal researcher will come up with a breakthrough for
Alzheimer's, for autism, or Parkinson's or diabetes--the answer,
Congressman Mulvaney, is unequivocally, yes. America needs to invest in
medical research. And the fact that you would question it really raises
the question of your judgment.
Let me tell you another thing that he is for, which I think is the
single most irresponsible budgetary position he has taken. He has been
an opponent of raising the country's debt ceiling.
What is the debt ceiling? That is America's mortgage. That is the
amount of debt we incur as a nation. It is a mortgage that is incurred
for things that we have already spent money on. So when we come and
vote for $600 billion for the Department of Defense and the
intelligence agencies and we don't have enough money coming in taxes to
pay for it, we have to extend America's mortgage to cover it.
Congressman Mulvaney says that is the wrong thing to do--extending the
debt ceiling of this country. While running for Congress, Congressman
Mulvaney, who now wants to manage our Nation's budget, pledged he would
never ever vote to raise the country's debt ceiling. He voted against
it four different times.
In 2011, when we were just about to breach the debt limit and default
on our national debt for the first time in the history of our country,
Mulvaney was a leading voice in support of default. He called it a
``fabricated crisis,'' and accused both parties of ``fear mongering.''
I am not sure what is more disturbing--Mr. Mulvaney's willingness to
default on our country's obligations, the full faith and credit of the
United States, or his lack of appreciation for the devastating economic
consequences which would follow. I can tell you what is at risk with
that kind of reckless attitude toward our Nation's debt. What is at
risk are the savings and investments and retirement accounts of
ordinary Americans across the Nation. Mr. Mulvaney may be willing to
gamble the full faith and credit of the United States; I am not.
Forcing the Federal Government to default on the Nation's debt would
harm the economy and affect the government's ability to make payments
to Social Security and Medicare recipients, military personnel,
veterans, Federal employees, defense contractors, State governments,
and to the bondholders of the United States, here and overseas.
We would lose our credibility if Mr. Mulvaney had his way and allowed
us to default on our national debt. We should not ever consider
confirming an OMB Director who has repeatedly risked the economic
security of our Nation to score political, rhetorical points.
Throughout his campaign, President Trump promised to protect Medicare
and Social Security and make decisions that would ``benefit American
workers and American families.'' That is a quote. However, instead of
making good on the promise, President Trump has chosen a man to head
the Office of Management and Budget who has led calls for devastating
cuts to Federal programs that millions of Americans rely on every day.
Mr. Mulvaney has said he wants to ``end Medicare as we know it,'' and
he has called Social Security a ``Ponzi scheme.'' He has called for
raising the retirement age for Social Security to 70, from the 67 that
it currently is. Well, 3 more years at work may not mean much to a
Member of Congress, because we sit down a lot in these comfortable
chairs and people bring us things when we need them. But 3 more years
of working before you qualify for Social Security means something to a
waitress, whose hips and ankles and knees have been bothering her for
years, but she has no choice but to get up every morning, go to work,
carry those trays, and try to bring enough money home to help a family.
It means something to someone who works in a coal mine--I guarantee you
that--3 more years at work, exposing yourself to the lung diseases and
other things
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that might come with the job. It means something to a truckdriver,
spending days and nights on the road. It means something to people who
have to move freight around. It is the kind of thing that means a lot
to ordinary working people. It clearly doesn't mean anything to
Congressman Mulvaney. Three more years working, as far as he is
concerned, is an acceptable alternative.
He wants to privatize Medicare and turn Medicare back into the loving
arms of private health insurance companies, and let's see what seniors
end up experiencing. Almost 60 million Americans now rely on Medicare.
In Congressman Mulvaney's point of view, the guarantee of Medicare
would end. This is the man President Trump has chosen to head the
budget for the United States of America. Mulvaney has called repeatedly
for cuts to Social Security, Medicare, and Medicaid, including a ``cut,
cap, and balance'' budget, which would cut each of these programs by 25
percent. When you say the word Medicaid, people have an image in their
mind: Oh, that is health insurance for poor people. And that is
generally correct, although it also covers disabled Americans. But do
you know who the major recipients of Medicaid are in America? The
largest single group of people receiving help from Medicaid are
children--children in poor, low-income families who get medical care
through Medicaid. The biggest expenditure for Medicaid is not children
though. The biggest expenditure is for the elderly Americans who are
living largely at institutional settings, in these care homes, nursing
homes. Medicaid keeps them in that place with adequate medical care. So
now comes Congressman Mulvaney and says: Let's just cut those by 25
percent. There is one good way to reduce Federal spending.
Really? So that means fewer immunizations for children. What does it
mean for your mother or your grandmother in the nursing home when it is
announced that we don't have enough money to cover the cost to keep her
here in a good, safe, positive environment? For Congressman Mulvaney,
it is just numbers on paper. For real families across America, it is
the reality of life.
Much like our new Secretary of Health and Human Services, Congressman
Price, Representative Mulvaney wants to dramatically undermine the
Medicare Program for our Nation's seniors. Let's look at what Medicare
has meant to our country since it was created in 1965. Before Medicare,
only 51 percent of Americans 65 and older had health care coverage.
Nearly 30 percent lived in poverty. Today, 98 percent of seniors have
health care, and less than 10 percent live below the poverty line. Has
Medicare work? You bet it has. It has provided health insurance for
seniors, and it has given people dignity and independence in their
senior years--something that everyone should value. And, incidentally,
the life expectancy of Americans has grown by 5 years since we created
Medicare. It is working. Medicare helps seniors, helps their families,
and it helps America. But Congressman Mulvaney doesn't get it.
This man has been chosen by President Trump to write the budget of
America. Why is Congressman Mulvaney so hell-bent on ending a program
like Medicare that 98 percent of our Nation's seniors depend on? Well,
I can tell you, if his comments on Medicare scare you, on Medicaid he
is even worse. This program, combined with the Children's Health
Insurance Program, ensures health coverage for 70 million Americans.
One out of every five nationwide depend on Medicaid. It helps low-
income families, pregnant women, children, and those with disabilities.
Currently, if you qualify for Medicaid, you are guaranteed to get
health coverage. Congressman Mulvaney thinks he has a better idea. He
wants to change that.
Congressman Mulvaney wants to significantly cut the Federal funding
for Medicaid and leave States to fend for themselves when it comes to
caring for these 70 million Americans. Faced with less Federal funding,
States would be forced to find ways to cut spending and save money.
They might start Medicaid waiting lists or impose work requirements or
slash benefits. At the end of the day, the result would be
catastrophic.
I just spent the last weekend in Southern Illinois. We had a
roundtable down there to talk about the impact of the repeal of the
Affordable Care Act. These hospital administrators from smalltown
hospitals came in to tell me that losing Medicaid reimbursement could
force them to dramatically cut their workforce and maybe even face
closure. Here is Congressman Mulvaney suggesting: Let's just do that
across America. I wonder where he lives. I wonder if there are any
small towns or rural areas near him. I wonder if he values those
hospitals the way the people living in communities that I represent
value them. These are not only lifelines for people who desperately
need timely, professional medical care, but they are the source of the
best jobs in the community. Congressman Mulvaney could care less: Let's
just keep cutting on Medicaid and see what happens.
What will happen will be devastating.
Mr. Mulvaney isn't content with just throwing seniors off Medicare
and low-income families off Medicaid. He wants to punish women by
taking away their healthcare providers and inserting his own decisions
into their medical decisions. Mr. Mulvaney has repeatedly attempted to
defund Planned Parenthood health centers, which provide women and men
with important cancer screenings, family planning, STD testing, and
other important health care services.
The laws of the United States of America provide that not one penny
can be given to Planned Parenthood for abortion services--not one penny
under the law. Most people, if asked what percentage of the Planned
Parenthood budget is actually spent on abortion services would get it
wrong. The actual number is 3 percent. Ninety-seven percent of what
Planned Parenthood does, in terms of family planning, cancer screening,
STD screening, has no relation directly to abortion services, and that
is compensated, but abortion services are not under the law.
Congressman Mulvaney could care less. He would close down the sources
of family planning in small towns and communities around America.
The concerns I have laid out today are just a few that I have about
this nomination. The millions of hard-working Americans who believed
President Trump's campaign promises, and as a champion for the most
vulnerable, deserve far better than Congressman Mulvaney.
There are real problems facing this Nation. Far too many people are
struggling, and there is a lot of work to do. We cannot afford to risk
our economic recovery, the retirement plans and savings of working
Americans, the health of our children, the kind of care we want for our
mothers and grandmothers--we cannot afford to risk them by appointing
OMB Director Mick Mulvaney.
I have no choice but to oppose Mick Mulvaney's nomination for
Director of the Office of Management and Budget.
Mr. President, Mick Mulvaney is a founder of the House Freedom
Caucus, which has made repeal of the Affordable Care Act--without a
replacement--one of their main causes. This is not about good policy or
the real consequences for people around the country. This is about
ideology.
Mr. Mulvaney wants to rip health insurance away from nearly 30
million people and deny people the important consumer protections they
have come to depend upon. He would once again allow insurers to impose
pre-existing condition exclusions and discriminate based on gender and
cut off coverage when someone gets sick and needs it most.
His answer to fixing our health care system is ``free-market
competition'' and ``crackdown on frivolous lawsuits. Those might make
good talking points, but they will not stabilize our insurance market
and help people in need.
The Illinois Hospital Association estimates that Republican plans to
repeal the Affordable Care Act will result in the loss of up to 95,000
jobs in Illinois--in hospitals, doctor's offices, construction, real
estate, and beyond.
Over the last month, I have been going around my State, meeting with
hospitals and providers, talking to them about what repeal would mean.
They are worried.
You see, Illinois hospitals and health systems generate nearly $90
billion in the State and local economies each year, and 1 in 10 jobs in
Illinois is in
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health care. Hospitals are vitally important to our State's economy and
vitally important to patients in need.
Don't just take my word for it, Franklin Hospital CEO, Jim Johnson
told me:
In our community, at the time that the hospital in West
Frankfort closed, we [Franklin Hospital in Benton] managed to
stay open . . . they're just eaten up that they don't have a
hospital anymore. It's incredible what the loss of a hospital
can do to a small community. And I'm down there talking to
those guys every day because naturally I like them to use our
hospital . . . but those conversations, it has just torn this
community apart.
In Illinois and nationwide, rural hospitals would be particularly
hurt by Mr. Mulvaney and Republicans' prescription for chaos.
In Illinois, 62 of our 102 counties are rural. We have 51 Critical
Access Hospitals, which are the hubs of their communities. Rural
hospitals typically are more reliant on Medicaid and Medicare, and have
tighter operating margins.
So what has the ACA meant for them? In States that expanded Medicaid,
like Illinois, rural hospitals have seen greater financial stability
thanks to the decrease in uncompensated care--or charity care--costs.
Thanks to the Affordable Care Act, the uninsured rate in rural
communities has dropped by nearly 40 percent. This is not only great
for those individuals obtaining insurance, it is also great for the
rural hospitals who are now getting paid for the health services they
provide.
Community Health & Emergency Services CEO Fred Bernstein told me:
You can look at Cairo as the ghost of the future. Because
there is not much left that we have to lose . . . We've lost
the only grocery store, and the only drug store in Cairo. If
this Affordable Care Act thing isn't resolved and if we go to
block grant in the Medicaid program, there's not going to be
any resolution to those problems down there. We are not going
to be able to stay open. At least 72-74 percent of my
patients depend upon Medicaid . . . Without the expansions of
Medicaid that we've already seen, and without some of the
subsidies that those who can get some insurance will get to
keep that insurance, there's not going to be the ability to
afford any care for most of the people we serve.
Since 2009, the number of rural hospitals in Illinois operating in
the red has decreased by 46 percent. Put another way, 16 rural
hospitals in Illinois are now on much more solid financial footing
thanks to the ACA.
I yield the floor.
The PRESIDING OFFICER. The Senator from Arkansas.