[Congressional Record Volume 163, Number 40 (Wednesday, March 8, 2017)]
[Senate]
[Pages S1697-S1702]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]





  PROVIDING FOR CONGRESSIONAL DISAPPROVAL OF A RULE SUBMITTED BY THE 
                   DEPARTMENT OF EDUCATION--Continued


                         Order for Adjournment

  Mr. McCONNELL. Mr. President, if there is no further business to come 
before the Senate, I ask unanimous consent that it stand adjourned 
under the previous order, following the remarks of Senators Lankford 
and Warren.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator from Oklahoma.
  Mr. LANKFORD. Mr. President, in December of 2015, President Obama 
signed the Every Student Succeeds Act after it passed this body with 
overwhelming bipartisan support--85 of 100 Senators supported the bill. 
The Wall Street Journal called the Every Student Succeeds Act ``the 
largest devolution of federal control to the states in a quarter-
century.'' It also had the support of Governors, State legislators, 
chief State school officers, school district superintendents, local 
school boards, principals, and teachers unions, who all agreed on the 
need to replace No Child Left Behind.
  The core of the education reform in the Every Student Succeeds Act 
was to restore local control to the States--not just control for them 
but that they would have the responsibility and the authority for 
things such as school accountability, teacher evaluation, student 
evaluation. It is very clear. In fact, the Every Student Succeeds Act 
says things very specifically. States are solely responsible for 
choosing which standards to adopt. The Secretary cannot mandate, 
direct, or control State standards. The Secretary of Education cannot 
require, coerce, or incentivize States to adopt common core State 
standards. States are responsible for choosing which assessments to 
adopt. The Secretary of Education cannot mandate, direct, or control 
State assessments for education. States design their own system for 
holding schools accountable and decide which schools to identify for 
school intervention and support. The Secretary cannot add new 
requirements or criteria on State accountability systems that are not 
in the law. States and local school districts decide what strategies 
they will implement to help fix identified schools without Federal 
interference. The Secretary of Education cannot prescribe how States 
and local school districts improve those schools.
  Congress passed that clear education law to take power out of 
Washington, DC, and from the Department of Education and the Secretary 
of Education and hand it back to the States.
  Five months after the bill was signed, the Obama administration 
changed their mind and released regulations to take back school 
decisionmaking and accountability, in direct violation of the law.
  Eighty-five of one hundred of us agreed that our passion is for every 
school district, every parent, every State to take care of every child; 
that no child would be left behind by switching to local control rather 
than Federal centralized control. But when this new rule was put out by 
the Obama administration, they reinterpreted that clear law. Let me 
tell you what they said in the rule.
  In the rule, they dictate to States the consequences for schools that 
don't annually test at least 95 percent of their students.
  They prescribe to the States and school districts how they would 
intervene and improve schools that don't exit from this identification 
process of being an underperforming school.
  They limit how States may measure school quality or student success 
based on 4-year graduation rates.
  They define how much weight States must afford to non-test-based 
indicators in their accountability systems.
  This regulation prescribes the long-term goals and measurements of 
progress that States would use for their student subgroups.
  This new regulation prescribes when schools may exit from 
comprehensive support based on improvement.
  This new regulation mandates that States comply with specific 
Washington, DC, created requirements instead of letting the school 
districts or the States determine how best to proceed on those 
requirements.
  This new regulation limits how States award school improvement 
funding to school districts and schools.
  This new regulation adds a new and burdensome reporting requirement 
every 4 years on States and local school districts that will drive up 
compliance costs and will divert resources away from students in the 
classrooms, in direct violation of what we passed.
  This new regulation requires States to establish a statewide 
definition for ``infective teacher,'' requiring a statewide system of 
evaluation controlled by DC.
  This new regulation limits how students are scored when they have 
exited from special education.
  This new regulation controls how the school report cards are created 
and how long they are.
  This is what we were exiting from with No Child Left Behind. We said 
in that vote for Every Student Succeeds that Washington, DC, should not 
do this. This rule directly violated the spirit and the letter of the 
law and will put the new Secretary of Education, Betsy DeVos, in charge 
of school evaluation, teacher evaluation, and student success. That is 
not her role or the intent of this law when we passed it, regardless of 
who is the Secretary of Education. Our intent was to provide maximum 
flexibility for the States and the parents. The rule is central control 
from Washington, DC.
  It is essential that we stop this rule right now. While some of my 
colleagues have said: Let's just wait, and we will do regulations, and 
we will unwind some of this--they are basically admitting that the 
Trump administration will fix the Obama administration overreach. I 
understand that statement. I think there will be some unwinding of 
regulations, but here is why it must be done right now--two reasons. 
One is, when we do this right now with a Congressional Review Act, we 
settle this forever, that no administration ever, as long as this law 
is in place, can repromulgate a rule and turn right back around and say 
Washington, DC, is going to control teacher evaluation, student success 
evaluation, and school evaluation. This ends that forever.
  The second thing is, right now schools in Oklahoma have already 
diverted resources in their administration, and they are filling out 
forms that are due to Washington, DC, in April to fulfill this new 
requirement that was put down by the administration. If we don't end 
this now, the districts in Oklahoma and in all of the States 
represented by this great Senate--their administrators will be working 
on forms for Washington, DC, rather than educating children at home. 
Let's get those folks back in the classroom, working on things that 
matter, not some form that no one in Washington, DC, will read anyway. 
Why don't we allow our schools to focus on educating kids instead of 
filling out forms for the Secretary of Education? That is the reason we 
passed the Every Student Succeeds Act.
  I encourage this body to support H.J. Res. 57 when it comes up. This 
will fix this overreach and will put a permanent marker down to say we 
meant it when Congress said to the administration: Do not control local 
education. Let the States and the parents do it.
  With that, I yield back.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. LANKFORD. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Sullivan). Without objection, it is so 
ordered.
  The Senator from Massachusetts.


      Nomination of Seema Verma and the Republican Healthcare Bill

  Ms. WARREN. Mr. President, I rise today to urge my colleagues to vote 
against the confirmation of Seema Verma to serve as Administrator of 
the Centers for Medicare and Medicaid Services.
  CMS oversees the administration of the Medicare and Medicaid 
Programs. These programs provide healthcare coverage to grandparents, 
people with disabilities, foster kids, seniors living in nursing homes, 
single mothers, and babies. CMS is also in charge of implementing many 
parts of the Affordable Care Act and making sure that the protections 
guaranteed in the law are enforced.

[[Page S1698]]

  In other words, CMS is the part of government that we entrust with 
carrying out the commitments we have made to protect our health and our 
access to healthcare. We need someone to run these programs who is a 
champion for Medicare, Medicaid, and the Affordable Care Act and 
someone who can stand up to Republicans in Congress and stand up to the 
Trump administration when they try to burn these promises and turn 
their backs on the people who need help.
  On Monday night, the Republicans finally revealed their latest plan 
to rip health insurance away from millions of Americans. After years of 
railing about how the ACA was too long and too complicated, the 
Republicans spent weeks working on a secret plan--locked in a room, 
hidden somewhere in the United States Capitol. They didn't want anyone 
to see it. Here is a news flash: If you have to hide your plans from 
the American public, that is a pretty good sign that you are headed in 
the wrong direction.
  Now we know why they were so afraid to let anyone else take a look at 
the plan. The plan is ugly--really, really, ugly. The Republicans' plan 
would rip health insurance away from millions of Americans.
  Right off the top, the bill will end the Medicaid expansion 
established in the ACA. Right now, 11 million adults are covered by 
that expansion, and the Republican plan will end it. That is right--end 
it. Millions more Americans are using ACA subsidies to buy their health 
insurance. For the families who need it most, those subsidies will be 
cut. For seniors, prices will rise, and that means millions more people 
will not be able to afford health insurance.
  The Republican bill promises tax credits to help people pay for their 
insurance, but this is an empty promise because the tax credits are 
designed to be too small to actually cover the costs of paying for 
healthcare. If you have a 2-month break in your health insurance 
coverage, no matter the reason, the Republican bill would let insurance 
companies charge you a 30-percent penalty on top of your premium for an 
entire year. That is right. If you lose your job and scramble to find a 
new plan, you have exactly 62 days to lock down that plan because 1 day 
longer than that, and you are slapped with a 30-percent penalty.
  By the way, it is not a penalty paid to the government to help 
finance healthcare. No. It is a penalty paid to a $1 billion insurance 
company. Republicans should be ashamed of themselves.
  Too bad if being able to buy affordable coverage on the ACA exchange 
has given you access to health insurance while you start your small 
business. Too bad if your healthcare has given you free cancer 
screening. Too bad if your healthcare has given you access to treatment 
for substance abuse disorder. All that is gone under the Republican 
plan.
  So there it is--the Republicans' plan to take away health insurance 
for millions and millions of Americans. The Republican plan is cruel, 
and it gets worse.
  The Republican healthcare plan gets worse because it also delivers a 
gut punch to the rest of the Medicaid Program--the part that predates 
the ACA by decades. It does so by putting a cap on overall funding that 
States can receive and then strictly limiting the growth in that cap. 
This growth rate is deliberately set lower than the actual growth rate 
in medical costs for Medicaid beneficiaries. Why? So Republicans can 
cut the Federal Government's commitment to Medicaid without using the 
word ``cut.''
  I don't know if they think we are just too dumb to notice, but they 
are cutting Medicaid. Of course, people will still get sick and will 
still need medical care, so what the Republicans are doing is shifting 
hundreds of billions of dollars in Medicaid costs to State governments, 
which will struggle to pick up the tab, or shifting those costs to 
hospitals and doctors, who will not get paid, or shifting it to the 
families themselves, who will try to manage those bills.
  Understand what that means. Right now, if you qualify for Medicaid 
coverage, you get Medicaid coverage. That has been the law for decades, 
but the Republicans want to change that. With the cap, if you qualify 
for Medicaid coverage, you will get something. Nobody is really sure 
what. All we know is that it will not cover your expected costs of 
care. Think about the impact of that.
  The reckless Republican plan will blow huge holes in State budgets. 
The Republican plan will blow huge holes in rural hospitals' budgets 
and in the budgets of opioid treatment centers and community health 
centers all across this country.
  Massachusetts is using some of its Medicaid funding right now to 
fight the opioid crisis, but the Republican plan makes it harder to 
wage that fight in Massachusetts and in every other State that is 
battling this terrible epidemic.
  The Republican plan will leave millions of people who have decent 
Medicaid coverage holding the bag when they get sick. That is not 
healthcare; that is a con job.
  But it gets even worse. The bill cuts funding for Planned Parenthood, 
which provides maternity care and birth control. It gives insurance 
companies the green light to jack up costs for people over 50, blowing 
up the limits that were established in the ACA to make sure seniors 
could afford healthcare.

  But there is one more very, very ugly reason the Republicans should 
be ashamed, and that is because while they are gutting Medicaid, 
slashing health coverage for sick Americans, and slapping penalties on 
people who lose insurance through no fault of their own, Republicans 
are also handing out hundreds of millions of dollars in tax cuts to 
rich people and giving a special gift to insurance company CEOs.
  The Republican plan repeals two Medicare taxes that apply only to 
high-income taxpayers. Who benefits most from this repeal? 
Millionaires. They get a full 80-percent of the tax cut. It is a 
benefit that is worth an average of $50,000 each. That is right. The 
tax cut that millionaires will get from the Republican plan to rip up 
healthcare is more than many families make in a year.
  The Republican plan also hurts Medicare by taking money away from the 
Medicare trust fund, where it really belongs.
  Right now, the law says insurance companies can deduct only $500,000 
in executive compensation, but the Republicans think that is too hard 
on insurance companies and their CEOs. So sad. So they have lifted the 
cap to a full $1 million. The Republicans are determined to help boost 
the pay of insurance company CEOs. No wonder the Republicans didn't 
want to let anyone see this plan.
  This is literally a backroom deal to strip away lifesaving healthcare 
from babies, to drive the costs out of sight for seniors, to deny help 
for people with disabilities, and to make insurance more expensive for 
hard-working entrepreneurs. In exchange, insurance company CEOs and 
millionaires get giant tax deductions. Unbelievable. Less health 
insurance for people who need it; more tax cuts for wealthy insurance 
company CEOs. This is the deal it took Republicans years to come up 
with? They should be ashamed.
  I have received letters and emails and calls from families in 
Massachusetts who depend on Medicaid and the ACA. These families are 
shouting as loudly as they can about how important Medicaid and the ACA 
are to them. We need someone running the CMS who is listening and 
someone who has their backs, who will tell Republican politicians that 
their secret deals are terrible, who will tell them that their plans to 
take away coverage will hurt people, who will tell them that their 
recklessness will blow up State budgets.
  Seema Verma has a deep knowledge of the Medicaid Program, having 
worked at the State level to design and implement Medicaid waivers. Ms. 
Verma says she wants to help States like Massachusetts invest in 
innovative ways to improve care for Medicaid beneficiaries while 
lowering costs--improve care and lower costs. That sounds great, but 
she has also advocated for changes to Medicaid that violate the 
fundamental principles of the program. She has designed Medicaid plans 
that impose work requirements as a condition of receiving Medicaid 
coverage even when they make no sense. She has sought to increase the 
out-of-pocket costs that Medicaid beneficiaries must pay and has put in 
place rules that lock people out of the program just at the moment they 
most need coverage.

[[Page S1699]]

  We need a CMS Administrator who will stand up to the backroom bullies 
who are plotting to gut Medicaid, not one who wants to sneak cuts into 
the very programs that need to be defended. For that reason, I oppose 
Ms. Verma's nomination.
  One of my constituents who receives Medicaid coverage in 
Massachusetts, Lee from Holliston, wrote me to say: ``I just need to 
know it is going to be okay.''
  Lee, I wish I could tell you that it is going to be OK, but I cannot 
tell you that. What I can tell you is that you are not alone. Americans 
depend on the ACA and Medicaid to provide healthcare coverage. They 
depend on it when they get sick, and they depend on it to stay alive. 
Now that the Republican politicians have finally emerged from their 
secret basement room and unveiled their ugly plans, I promise you I am 
in this fight all the way. We need millions of people like you all 
across this Nation to make their voices heard so that Republican 
politicians do not destroy your healthcare.
  In January, Senator Stabenow and I held a forum for the then-nominee 
for Secretary of Health and Human Services, Tom Price. At this forum, 
we heard from individuals who were concerned about the impact that cuts 
to Medicare and Medicaid would have on their lives. I would like to 
share some of my interactions with a few of these individuals back in 
January by reading from the transcript Senator Stabenow introduced into 
the record at Congressman Price's hearing before the Finance Committee.
  I started by thanking everyone for being there and said this about 
where we were:

       Yesterday at the hearing for Congressman Price to be 
     Secretary of HHS, I asked him about the cuts that he has 
     proposed to Medicare and Medicaid. He's already proposed $449 
     billion in cuts to Medicare and over $1 trillion in cuts to 
     the Medicaid program. And so I asked him if he would commit 
     to follow through on Donald Trump's promise, ``I won't cut 
     Medicare or Medicaid.''

  There was a lot of dancing back and forth, but the bottom line is 
that no, he would not make that commitment, which I suppose should not 
have been a surprise.
  What I want to do as briefly as I can is to focus just a little bit 
on down the line and put a face on that, what it means to put those 
kinds of cuts into the system.
  I started with Ms. Fleming, and here is what I asked her.
  I said: ``You used to work at United Airlines. . . . How many years 
did you pay into the Medicare system?''
  Ms. Fleming said: ``Thirty-nine years.''
  I asked: ``How long have you worked there?''
  Ms. Fleming said: ``Thirty-nine years.''
  I said: ``Thirty-nine years that you paid into the Medicare system. 
Where else is it we need to spend $449 billion so that you can spend 
more out-of-pocket? So that money can go somewhere else--like tax cuts 
for rich people?''
  I asked Ms. Jensen:

       Just because I want to be clear about this, one of the 
     things that Medicaid does is make sure you get access to 
     mental health services. If you lose that access, what happens 
     in your life?

  So I had asked Ms. Fleming about the Medicare cuts. Here is what Ms. 
Jensen told me about the Medicaid cuts:

       That would entirely change my life. I wouldn't be able to 
     afford the services I need. My medications alone, right now, 
     run about as much as my rent. And I know that weekly 
     counseling or therapy sessions would really be out of reach. 
     It would threaten not only the growth of my business but the 
     existence of my business.

  She runs her own small business.
  She said:

       Basically: no Medicaid, no business. That would kind of be 
     the end of one of my dreams. And untreated disorders--my 
     untreated disorder--I know I would retreat from society. I 
     would retreat from my loved ones. I would not be a productive 
     citizen. I would probably get into trouble and cost the 
     taxpayers some money. Mental and behavioral health is no 
     joke. There are fatal consequences, and it's a matter of life 
     and death for a lot of people, including me.

  Then I turned to the third of our witnesses, Ms. Serafin. She has 
dealt with both systems--both Medicare and Medicaid--and I asked her to 
focus just for a minute on the Medicaid part of that. She was taking 
care of her elderly mother.
  I said:

       Your mother--after your father passed--your mother 
     declined, needed full time care. And she was supported by 
     Medicaid during that period of time. She was able to be in a 
     facility that could take care of her.
       If Medicaid had not been available to you, if there had 
     been a trillion-dollar cut to Medicaid, what would have 
     happened to you and your husband?

  Here is what Ms. Serafin said:

       Well, physically, I could not take care of anyone else.

  She had her own disabling medical problems. She said:

       I can hardly take care of myself. So, we would have had to 
     hire someone, or we would have had to move because our home 
     was not accommodating for another person with a disability.
       Secondly, the care my mother received in the nursing home 
     was so personally gratifying. I could sleep at night. My 
     mother was a really strong woman. She could have been a CEO. 
     She was born in the wrong era. But as a daughter--as mothers 
     and daughters often do--we didn't always see eye to eye on 
     everything!
       The people in the nursing home loved her--they loved her 
     feisty manner, they loved the things she would say. And I 
     would think, ``Oh, God, I would never say that!'' But they 
     thought she was wonderful.

  I made the point that my mother was a little like that too.
  Ms. Serafin said:

       I would sleep at night. I could feel good. Because I cannot 
     do things as it is for myself, and there were loving people 
     who would go to her and say, ``I love you, Anita,'' and it 
     just made my heart feel that wonderful feeling.

  So that is the face of Medicaid.
  We had one more witness, and this witness was Ms. Ornella, who had 
her son Sam with her.
  I said:

       Sam is the happy face of Medicaid. Sam is a little boy who 
     was born with multiple difficulties and who flourishes and 
     who receives support from Medicaid.

  So I asked:

       If there's a trillion dollars in cuts to Medicaid, and Sam 
     is not able to get the help he needs through Medicaid, what 
     happens to Sam?

  Ms. Ornella said:

       We barely qualified for Medicaid as it was, so if there 
     were any cuts to it, we would have been in that group of 
     people who I believe wouldn't have qualified. Medicaid has 
     provided him to be able to go to his kidney doctors and keep 
     his status check on his kidneys, which is what we think his 
     long-term issues are going to be.
       Medicaid has been there to cover tests for swallowing, for 
     swallowing functions, for all the different parts of his body 
     that are affected by his disorder. So my fear is, that if we 
     do get employer-based coverage, anything can happen in life--
     what if my husband lost his job and then we didn't qualify 
     for Sam to get Medicaid anymore? How would we deal with that 
     double whammy of losing employer coverage and then not 
     qualifying for Medicaid for a medically complex child?

  We heard from four people at this forum, and I am very grateful to 
all four of them for putting a face on what Medicare and Medicaid 
means. I suggested to Congressman Price that if he is confirmed to be 
the head of HHS, that he cut out the statement that Donald Trump had 
made, ``I will not cut Medicare or Medicaid,'' and that he tape it 
above his desk and look at it every single day. Because that is what 
the people at that hearing were all about.
  They are the reason we must not cut Medicare and we must not cut 
Medicaid, and I thanked them all for being with us.
  Alice, Sam, Diane, and Ann really put a face on the importance of 
Medicare and Medicaid at that forum.
  I have heard from a number of hospitals, community health centers, 
and behavioral health organizations in Massachusetts about the 
importance of Medicaid to them for being able to provide essential 
services to the people who need it most, and I want to share some of 
the comments they have given to me.
  John Nash, the CEO of Franciscan Children's Hospital, highlighted the 
importance of Medicaid in providing healthcare coverage for our 
children. Here is what he wrote to me:

       Dear Senator Warren, at Franciscan Children's, our mission 
     is to provide a compassionate and positive environment where 
     children with complex medical, mental health, and educational 
     needs receive specialized care for people who are committed 
     to excellence, innovation, and family support, so that these 
     children can reach their fullest potential and live their 
     best lives. Located in the Boston metropolitan area, we are 
     one of four institutions in the country offering this unique 
     array of services to children with complex needs.

[[Page S1700]]

       In Massachusetts, we are the only pediatric, post-acute 
     care provider that offers hospital-level care for children 
     with complex medical conditions. We are also one of the 
     largest pediatric mental health providers in Massachusetts, 
     offering a complete continuum of inpatient, residential, and 
     outpatient programming to ensure that children have access to 
     the services they desperately need.
       Franciscan Children's is proud to be an independent, 
     unaffiliated provider that coordinates across the healthcare 
     system to deliver high-quality, low-cost, specialty services 
     to children who come to us from every major health system and 
     intensive care unit from across the State. Collectively 
     across our programs, we serve more than 12,000 children a 
     year.
       Families who have had a child or children with special 
     needs often face tremendous financial burdens. Many 
     view hospitals like ours as a second home. Almost 60 
     percent of the families that we serve in our inpatient 
     medical program are on Medicaid.
       In federal discussions about the Affordable Care Act, it is 
     crucial to realize that Medicaid is the most important health 
     coverage program for children. As many as 30 million children 
     nationally and 355,000 children in Massachusetts (29.6% of 
     the state population of children) are covered. Children 
     covered by Medicaid--compared with those who are uninsured--
     generally go on to enjoy better health, lower rates of 
     mortality, and higher educational and economic outcomes as 
     they become adults.
       Massachusetts is seeing the returns on investments made in 
     Medicaid. Our rate of uninsured children is at the lowest on 
     record. Cuts to Medicaid will have a negative impact on 
     children and may increase healthcare costs. Furthermore, any 
     cuts to the Medicaid program will threaten our institution's 
     long-term ability to serve children and their families who 
     may not receive care otherwise. As the population of children 
     with complex needs continues to grow at the rate of 5 percent 
     annually, these funds will be vital to our future and to 
     theirs.
       We support the belief that access to affordable care is 
     essential for all individuals. Our families, whose resilience 
     and strength continues to inspire us every day, depend on 
     this principle being upheld. Our children deserve every 
     opportunity to reach their fullest potential and live their 
     best life.

  This letter is just a reminder of who gets Medicaid and how Medicaid 
changes the lives of the children who need it most and of their 
families. We cannot cut this program without taking away the futures of 
these children. This is an economic issue, but it is also a moral 
issue.
  I heard from the Behavioral and Health Network, a nonprofit community 
behavioral health agency in Western Massachusetts, and they shared with 
me an individual story they wanted to tell me about Tasha.
  Tasha went from homelessness to addiction and then to recovery--
highlighting the importance of Medicaid funds in supporting individuals 
who are dealing with substance abuse disorder. The behavioral health 
network shared a story, and this is how they tell it:

       Tasha M. recalls how her addiction started. She never 
     envisioned how and where it would end. As a teenager, she 
     remembers being homeless, her mom surrendering her to foster 
     care twice and living a dysfunctional life, leading to the 
     development of an eating disorder and hospitalization.
       It was during that hospital stay where she was also 
     receiving treatment for an injured back, that she was 
     prescribed a bottle of painkillers. That started Tasha on the 
     road to addiction, and ultimately to BHN's, ``My Sister's 
     House''--and her eventual recovery.
       Once addicted to pain pills she remembers ``hospital 
     hopping'' to feed the addiction. ``I felt so alone,'' she 
     said. Moving in with an aunt brought the prospect of turning 
     the page and leaving her addiction behind. Instead, Tasha 
     started to work as a bartender, ultimately succumbing to 
     alcohol and hitting bottom. Tasha says, ``I lost 
     everything.''
       Moving back to Massachusetts, she ``tried to start anew.'' 
     But instead she found herself back in the clubs and around 
     alcohol and, eventually, in a detox program through BHN's 
     Carlson Center. After that one-week stay, she entered Hope 
     Center, a BHN 30-day recovery addiction treatment program in 
     Springfield. Once released, the grip of addiction surfaced 
     again. ``I remember getting ready to go clubbing with my 
     boyfriend. We were in line to go into a club and I realized I 
     didn't have my ID. I went home and I found my ID lying on top 
     of my AA book. I thought, `wow, that's a sign'--and I need to 
     get back in the program.''
       BHN assisted with entry into My Sister's House, a BHN 
     community-based program for women in recovery, where its 
     residents have daily therapy and support, peer meetings and 
     are connected to community resources.
       It is also where Tasha met an intern who inspired her. ``I 
     remember I was one of her first clients. She said I couldn't 
     go back to my old ways . . . she really believed in me.''
       Tasha's recovery has come full circle. After successful re-
     entry into the community, she acquired a job as an 
     administrative assistant at a daycare center, and eventually 
     became a social worker helping mothers of children navigate 
     the complexities of parenting.
       Tasha's story doesn't end there. Tasha was offered a 
     position at My Sister's House, where she assists other young 
     women who find themselves on the sometimes bumpy road to 
     recovery. ``For me, it's about giving back . . . I'm grateful 
     to them.''
       About the new opportunity to help others at My Sister's 
     House, Tasha said: ``I always said to myself I was going to 
     come back to this House . . . this is my second home.''
       Tasha's journey was supported by an organization whose 
     funding is 56 percent State and Federal contracts and 42 
     percent fees from Medicaid, Medicare and a small percentage 
     of private insurances. Clearly, the impact of affordable 
     insurance and funds from CMS and the State creates needed 
     access and opportunities for changing lives [like 
     Tasha's]. Individuals can embrace help, move beyond 
     despair and hardship, and establish meaningful life 
     experiences, employment and self-sufficiency. Without 
     affordable insurance, Medicaid and Federal and State 
     funds, that could not happen.

  Thank you, Tasha, for telling your story. Thank you to the Behavioral 
Network for sharing your story. Thank you for all of the amazing work 
that you do every single day.
  The Boston Medical Center, the State's largest safety net hospital, 
also shared their perspective on how changes and cuts to Medicaid would 
seriously impact the progress they have made in working to provide 
high-quality, cost-effective care to their patients. Here is what 
Boston Medical Center said:

       At Boston Medical Center (BMC), our mission is to provide 
     Exceptional Care without Exception to all of our patients. As 
     the largest health safety net system in Massachusetts and in 
     New England, BMC and the patients we serve would be severely 
     impacted by major changes to the Affordable Care Act.
       Massachusetts health care reform in 2008, and subsequently 
     the Affordable Care Act, supported our efforts to provide 
     high-quality, cost effective care to the many, formerly 
     uninsured, patients who became insured through Medicaid and 
     subsidized products. BMC has worked diligently with the 
     Commonwealth of Massachusetts and the Center for Medicare and 
     Medicaid Services (CMS) to transition the payment and 
     delivery of Medicaid services in a more cost effective 
     manner. With a strong understanding of the need to ensure 
     that the future of Medicaid is sustainable, our collective 
     efforts have begun to produce encouraging results.
       Medicaid--and access to affordable, subsidized health care 
     insurance--is an important federal/state partnership that 
     allows the most vulnerable in our population to receive the 
     health care they need. At BMC, we see firsthand how it 
     affects the lives of our patients. In addition to providing 
     funding for important primary care services, it is a lifeline 
     for those with chronic diseases and mental health and 
     substance abuse needs.
       BMC has used Medicaid funding to develop and implement a 
     number of very promising programs aimed at improving the 
     quality of care for our low-income population and doing it in 
     a manner that is the most cost effective. We aim to keep our 
     patients out of the hospital while giving them the care 
     necessary to lead fulfilling lives.
       Some of these efforts include innovative programs for 
     pregnant women and babies both before and after delivery. 
     Post-partum depression is an all-too-common issue for new 
     mothers. BMC has designed a program that embeds necessary 
     behavioral health services into the OB/GYN visit setting, 
     thereby allowing them to receive the necessary mental health 
     care along with their medical visit.
       At the same time, we have several successful programs 
     focusing on newborn infants--ranging from babies born 
     prematurely to those born addicted to drugs. As New England's 
     largest trauma center, we routinely treat large numbers of 
     patients who have been victims of violence. In an effort to 
     help break the trend of violence in the inner city, BMC 
     offers many programs that help those victims break that cycle 
     through counseling, education and support.
       Boston, like many cities across the country, has seen an 
     unacceptable level of opioid related deaths. Probably our 
     most critical efforts today include programs that 
     successfully treat opioid and other drug addictions while 
     guiding patients toward prevention of future drug abuse and a 
     life where they can hold a job and maintain their 
     relationships with their families.
       Working with the Commonwealth, BMC has also used Medicaid 
     funding to redesign how health care is provided in a manner 
     that ensures the highest quality patient care in the most 
     affordable, patient-centric manner. The groundwork has been 
     laid over the last several years with Medicaid waiver 
     funding. As we prepare for implementation of the Medicaid 
     waiver extension, we have just begun to roll-out our Medicaid 
     Accountable Care Organization, (ACO). The ACO structure 
     requires that we will be accountable for the full cost of 
     each Medicaid patient's health care, while it will allow the 
     flexibility to provide the right care that might not have 
     previously been covered (e.g. purchase of humidifier for an 
     asthmatic child that will help prevent hospitalizations). 
     Patients will benefit through further integration of care 
     across the delivery system continuum,

[[Page S1701]]

     while reimbursement for the cost of treating those patients 
     will be contained in a defined agreement.
       These important Massachusetts efforts of transforming the 
     delivery and payment system for Medicaid will be dealt a 
     serious blow if the underlying Medicaid funding is changed. 
     Additionally, if Medicaid and subsidized healthcare 
     eligibility changes result in our patients losing access to 
     affordable health care, not only will the patient's quality 
     of life suffer, but the lack of funding will not allow [us] 
     to continue to provide those patients with many of these 
     critical services.
       BMC is committed to maintaining the provision of 
     exceptional care without exception and it will require the 
     financial partnership with the federal and state government 
     to ensure that our low-income patients have access to that 
     care.

  Boston Medical Center absolutely provides ``Exceptional Care without 
Exception,'' and Medicaid helps them carry out that critical work.
  The Boston Center for Independent Living shared with me a story from 
a constituent named Ty who receives healthcare from One Care, a program 
in Massachusetts that integrates care for beneficiaries who are dually 
eligible for both Medicare and Medicaid. So I will tell a little bit 
about Ty's story.

       Ty Muto, a 39-year-old transgender man, was recovering from 
     colon surgery in 2014 when he stopped outside of his work and 
     was assaulted by three men yelling homophobic slurs. He 
     survived the attack with a traumatic brain injury and spinal 
     cord injury and is only alive thanks to several necessary, 
     timely medical interventions. A former mediator and American 
     Friends Service Committee volunteer, Ty is enrolled in One 
     Care with the Commonwealth Care Alliance. They provide 
     medical care, visiting nurse support, physical therapy, and 
     medical rides. His Care Manager helped him apply for Social 
     Security and find housing, which really improved his life! On 
     several occasions his visiting nurse has identified urgent 
     medical conditions and he has been able to take a medical 
     ride to the hospital where he receives care--avoiding lengthy 
     and expensive emergency room visits at local hospitals that 
     aren't equipped to care for his specific condition. Ty says 
     the only reason he's alive today is because of all of the 
     services and care he gets through One Care.

  That is the work being done at the Boston Center for Independent 
Living, and it can only be done because they receive the support of 
Medicare and Medicaid.
  The Boston Center for Independent Living also shared with me a story 
from another constituent named Olivia.

       Olivia Richards is a 33-year-old woman on One Care and, as 
     she emphasizes, a lifelong Bruins fan! Her plan with CCA 
     allows her to be an active member of the community and her 
     care coordinator assists her in managing her seizure 
     disorder, paraplegia, PTSD, and ADHD. Olivia grew up in the 
     foster care system and, after college, rather than move in 
     with an abusive family member, she tried to make it on her 
     own and she ended up homeless. Left without insurance--and 
     trying to keep up with her di-lanthin, ADHD and asthma 
     medications from seven- to fourteen-day sample packs from a 
     free clinic--she went on and off medication and eventually 
     ended up in a psychiatric hospital for a month.
       If she had been making that transition in the post-
     Romneycare age, she would have maintained her health 
     insurance and been able to stay on MassHealth. Olivia raves 
     about her coordinated care manager (CCA) and how she's helped 
     stabilize Olivia's health--recognizing issues before they 
     become emergencies. Prior to One Care, Olivia went to the 
     emergency room every few months with a severe UTI that landed 
     her in the hospital. Her care coordinator recommended she see 
     an infectious disease doctor, who prescribed a preventive 
     antibiotic--something none of the many doctors she'd seen had 
     put together. Olivia hasn't been to the hospital for a UTI 
     since.
       This time around, when Olivia needed emergency care, her 
     care coordinator sent community medics to her apartment--
     providing her with better care and avoiding an expensive 
     emergency room visit and other complications. Before One 
     Care, Olivia was using a third-hand wheelchair with a bent 
     frame and a wheel that she had to weld back together every 
     few months. Medicare and Medicaid kept dodging responsibility 
     for wheelchair repairs. Olivia's care coordinator helped her 
     get a new chair.

  That is a real quality-of-life improvement for Olivia.
  I want to say a special thank you to both Ty and to Olivia for 
sharing their stories, for letting us make them public, and a very big 
thanks to the Boston Center for Independent Living for all that you are 
doing every single day to help the people of Massachusetts. We are all 
deeply grateful for your work, and we want to continue to support it 
here in Congress.
  Many of my constituents have written to me, fearful of what changes 
to Medicare or Medicaid might actually mean to them. Jeffrey, who is 
from Gardner, wrote to me to share his constant worries about health 
insurance coverage. This is what he wrote:

       Dear Senator Warren,
       I hope this message finds you well, and I want to thank you 
     for your continued fight for the rights of everyone in 
     Massachusetts & the nation.
       Unfortunately, this election has left me with some constant 
     worry, as I'm sure it has many. I'm a graduate student and 
     have a year and a half left until I complete my masters 
     degree in counseling psychology.
       Obviously because of this, I work part-time, and am not 
     offered health insurance through my employer. I have been on 
     MassHealth (Tufts Network Health, to be exact) since 2013 
     when I decided to make a career change.
       I have some issues that require prescriptions and doctors 
     visits monthly. I'm not sure if they can be deemed as 
     preexisting conditions, but these are prescriptions I can 
     certainly not go without, nor could I go without insurance 
     for a year and a half.
       Obviously I don't enjoy being on MassHealth, but for right 
     now it's what is necessary. My question may be a difficult 
     one to answer, due to the fact that no one truly knows what 
     will happen after inauguration day. I do know Massachusetts 
     is better protected than other states to keep its citizens 
     insured, and I know that you and Governor Baker have vowed to 
     fight for this right, as well as for many others--which I 
     could not be more thankful for!
       If the new establishment has their way and repeals federal 
     funding to Medicaid, will people in Massachusetts such as 
     myself be thrown off their insurance? I know we rely heavily 
     on a waiver that was signed recently, and it's a ``wait and 
     see matter,'' but I suppose my question is, will I be 
     protected since I have documented needs for insurance already 
     in place? Or are my conditions going to be deemed ``not 
     severe enough?''

  All I can say, Jeffrey, is we don't know yet, but I can promise you 
that I am fighting to make sure you remain protected.
  Elise from Scituate wrote to me about the importance of Medicare and 
Medicaid funds in supporting nursing homes, adult day health programs, 
and other needs of older adults. Here is what Elise had to say:

       Dear Senator Warren,
       I am writing to you because I am very concerned about the 
     direction of the incoming administration, President-Elect 
     Trump, and his cabinet choices. It was certainly a difficult 
     election period. The policies and direction of these 
     individuals is particularly troubling for those who are 
     older, or who may have mental illness, disabilities, or 
     developmental challenges.
       As many are not aware, the federal rules, regulations, and 
     budget do affect the management of services in the states. As 
     a consultant in Massachusetts in both nursing homes and 
     adult day health programs, I see the strong need for 
     cooperative and supportive federal and state funding as 
     well as regulatory processes for ongoing care. Very few of 
     the individuals in these settings are paying privately. 
     Medicare and Medicaid--as well as the VA--are the major 
     funders for these programs.
       In Massachusetts, we have 45,000 nursing home beds, or 
     approximately 400 skilled nursing facilities. Home care 
     incorporates adult day health, and we have roughly 14,600 
     participants in Massachusetts alone. Our population is aging, 
     and access to good services are critical to good care and 
     quality of life.
       In addition, there are many programs that continue to need 
     commitment and funding to manage necessary services to 
     individuals. These include: housing (Section 8), elder and 
     those with disabilities home care, services to the blind, and 
     community mental health care--to name a few.
       Changes in these benefits would jeopardize the delicate 
     balance of home and community care, rehabilitation, and 
     perhaps ultimately end up costing more for care. For example, 
     if we don't have resources to assist people to return to the 
     community, institutional care may be the only answer--and a 
     costly one.
       The notion of having poor individuals pay for their 
     Medicaid benefits, and/or privatizing this to an insurance 
     base is ill-founded and often becomes costly to manage, as 
     well as lowers benefits. Aside from providing services to our 
     citizens, the reduction in these programs will drag the 
     overall economy down.
       The healthcare industry (private enterprise) is dependent 
     upon a multitude of programs to generate profit. For example, 
     if Mr. X needs a wheel chair and Medicare does not pay for 
     one, Mr. X will not pay for a new wheel chair. He will either 
     borrow one, or purchase one used, or perhaps ``do without.'' 
     This scenario, regardless of the product, will duplicate 
     itself throughout health care and service provision. 
     Companies that have dependency upon Medicare funds may have 
     to close or cut back. Service providers, such as Visiting 
     Nurses, will be facing similar results.
       I have been in the older adult/health care/medical field 
     since 1969. I have seen changes over time to services from 
     government provisions to privatization. Privatization is the 
     one of the poor outcomes when government monies are used to 
     pay for services rendered. I remain a very strong advocate 
     for individuals and their families as they try to meet

[[Page S1702]]

     the challenges of obtaining just and fair services.

  Thank you, Elise. I appreciate your writing. Medicare and Medicaid 
provide critical funds to support nursing homes and senior citizens in 
Massachusetts. I agree that we must fight to protect these programs.
  I have many constituents writing in. My constituents are shouting as 
loudly as they can about the need to protect Medicare and Medicaid. We 
need a CMS Administrator who will stand up for Tasha and for other 
individuals who are struggling with addiction, who will stand up for 
those who are relying on Medicare to help with Parkinson's, who will 
stand up for our hospitals and healthcare providers to ensure that they 
have the resources they need to adequately serve their patients. I am 
listening. I am fighting.
  Republicans are trying to cut backroom deals to end these 
protections. I promise you, I will do everything in my power to prevent 
them from destroying your healthcare. That is why I am here.

                          ____________________