[Congressional Record Volume 163, Number 41 (Thursday, March 9, 2017)]
[Senate]
[Pages S1719-S1724]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                             Cloture Motion

  The PRESIDING OFFICER. Pursuant to rule XXII, the Chair lays before 
the Senate the pending cloture motion, which the clerk will state.
  The bill clerk read as follows:

                             Cloture Motion

       We, the undersigned Senators, in accordance with the 
     provisions of rule XXII of the Standing Rules of the Senate, 
     do hereby move to bring to a close debate on the nomination 
     of Seema Verma, of Indiana, to be Administrator of the 
     Centers for Medicare and Medicaid Services, Department of 
     Health and Human Services.
         Mitch McConnell, Steve Daines, John Cornyn, Tom Cotton, 
           Bob Corker, John Boozman, John Hoeven, James Lankford, 
           Roger F. Wicker, John Barrasso, Lamar Alexander, Orrin 
           G. Hatch, David Perdue, James M. Inhofe, Mike Rounds, 
           Bill Cassidy, Thom Tillis.

  The PRESIDING OFFICER. By unanimous consent, the mandatory quorum 
call has been waived.
  The question is, Is it the sense of the Senate that debate on the 
nomination of Seema Verma, of Indiana, to be Administrator of the 
Centers for Medicare and Medicaid Services, shall be brought to a 
close?
  The yeas and nays are mandatory under the rule.
  The clerk will call the roll.
  The bill clerk called the roll.
  Mr. CORNYN. The following Senators are necessarily absent: the 
Senator from Georgia (Mr. Isakson), and the Senator from Florida (Mr. 
Rubio).
  Further, if present and voting, the Senator from Florida (Mr. Rubio) 
would have voted ``yea.''
  The PRESIDING OFFICER. (Mr. Perdue). Are there any other Senators in 
the Chamber desiring to vote?
  The yeas and nays resulted--yeas 54, nays 44, as follows:

[[Page S1720]]

  


                       [Rollcall Vote No. 85 Ex.]

                                YEAS--54

     Alexander
     Barrasso
     Blunt
     Boozman
     Burr
     Capito
     Cassidy
     Cochran
     Collins
     Corker
     Cornyn
     Cotton
     Crapo
     Cruz
     Daines
     Donnelly
     Enzi
     Ernst
     Fischer
     Flake
     Gardner
     Graham
     Grassley
     Hatch
     Heitkamp
     Heller
     Hoeven
     Inhofe
     Johnson
     Kennedy
     King
     Lankford
     Lee
     Manchin
     McCain
     McConnell
     Moran
     Murkowski
     Paul
     Perdue
     Portman
     Risch
     Roberts
     Rounds
     Sasse
     Scott
     Shelby
     Strange
     Sullivan
     Thune
     Tillis
     Toomey
     Wicker
     Young

                                NAYS--44

     Baldwin
     Bennet
     Blumenthal
     Booker
     Brown
     Cantwell
     Cardin
     Carper
     Casey
     Coons
     Cortez Masto
     Duckworth
     Durbin
     Feinstein
     Franken
     Gillibrand
     Harris
     Hassan
     Heinrich
     Hirono
     Kaine
     Klobuchar
     Leahy
     Markey
     McCaskill
     Menendez
     Merkley
     Murphy
     Murray
     Nelson
     Peters
     Reed
     Sanders
     Schatz
     Schumer
     Shaheen
     Stabenow
     Tester
     Udall
     Van Hollen
     Warner
     Warren
     Whitehouse
     Wyden

                             NOT VOTING--2

     Isakson
     Rubio
  The PRESIDING OFFICER. On this vote, the yeas are 54, the nays are 
44.
  The motion is agreed to.
  The Senator from Kansas.
  Mr. MORAN. Mr. President, I ask unanimous consent that 
notwithstanding the provisions of rule XXII, following leader remarks 
on Monday, March 13, the Senate resume executive session for the 
consideration of Executive Calendar No. 18, and that the vote on 
confirmation occur at 5:30 p.m.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Mr. MORAN. Mr. President, on behalf of the majority leader, there 
will be no further votes this week in the U.S. Senate.
  Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant bill clerk proceeded to call the roll.
  Mr. WYDEN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. WYDEN. Mr. President and colleagues, today the Senate turns to 
consider the nomination of Seema Verma to be the Administrator of the 
Centers for Medicare and Medicaid Services.
  I would be the first to say that in coffee shops across the land, 
people are not exactly buzzing about the office known as CMS, but the 
fact is, this is an agency that controls more than a trillion dollars 
in healthcare spending every year. Even more important and more 
relevant right now, if confirmed, and if TrumpCare somehow gets rammed 
through the Congress over loud and growing opposition, this is going to 
be a major issue on her plate right at the get-go.
  I thought it would be useful to just give one example of the 
connection involved in this legislation. TrumpCare cuts taxes for the 
special interests and the fortunate few by $275 billion, stealing a 
chunk of it from the Medicare trust fund that pays for critical 
services to the Nation's older people.
  If TrumpCare passes and Ms. Verma is confirmed, under section 132 of 
the bill, she would be able to give States a green light to push the 
very frail and sick into the high-risk pools that have historically 
failed at offering good coverage to vulnerable people at a price they 
can afford. Under section 134 of TrumpCare, Ms. Verma would be in 
charge of deciding exactly how skimpy TrumpCare plans would be and how 
much more vulnerable people would be forced to pay out of their pockets 
for the care they need.
  Under section 135 of the bill, if confirmed, Ms. Verma could be 
paving the way for health insurers to make coverage more expensive for 
older people approaching retirement age.
  Given all that, I want Members to understand there is a real link 
between this nomination and the debate about TrumpCare, and this is, in 
effect, the first discussion we have had about TrumpCare since these 
bills started to get moving without any hearings and getting advanced 
in the middle of the night.
  The odds were against Republicans writing a single piece of 
legislation that would make healthcare more expensive, kick millions 
off their coverage, weaken Medicare and Medicaid, and produce this 
Robin Hood in reverse, this huge transfer of wealth from working people 
to the fortunate. Nobody thought you could do all of that at the same 
time, but somehow the majority found a way to do it. Republicans are 
rushing to get it passed before the American people catch on.
  As part of this debate about Seema Verma, we are going to make sure 
people understand this nomination is intertwined with what happens in 
the discussion about TrumpCare and how these particularly punitive 
provisions with respect to Medicare and Medicaid would affect our 
people.
  For 7 years, my colleagues on the other side have pointed to the 
Affordable Care Act as pretty much something that would bring about the 
end of Western civilization and, at a minimum, would basically continue 
a system responsible for every ill in our healthcare system. That was 
the argument. The Affordable Care Act is responsible for just about 
every ill and will practically be the end of life as we know it.
  Their slogan was to ``repeal and replace,'' and it was a slogan they 
rode through four elections to very significant success. The only 
problem was, it was really repeal and run, and that replacement was 
nowhere in sight. Now the curtain has been lifted. The lights are 
shining on TrumpCare, and it sure looks to me like there are a lot of 
people not enjoying the movie. TrumpCare goes back to the days when 
healthcare in America mostly worked for the healthy and the wealthy.
  We have a lot of debate ahead, so we are not going to just lay it all 
out here in one shot.
  I do want to mention some key points on the roll that Ms. Verma, if 
confirmed, would play. I want to start by addressing what this means in 
terms of dollars and cents.
  If you look at the fact that the Medicare tax, which everybody pays 
every single time they get a paycheck, and that money is used to 
preserve this program that is the promise of fairness to older people--
the Medicare tax would be cut for only one group of Americans in this 
bill. I find this a staggering proposition. The people who need it the 
least, couples with incomes of over $250,000, people who need it the 
least would be given relief from the Medicare tax--not working 
families, just the wealthy.
  As I indicated, we are talking all told about $275 billion worth of 
tax cuts to the special interests and the fortunate few, and it is 
largely paid for by taking away assistance to working people to help, 
for example, pay for their premiums.
  I brought up the ACA Medicare payroll tax for a reason because I 
think when Americans look at their next paycheck--if you are a cop or a 
nurse and you get paid once or twice a month and you live, say, in Coos 
Bay, OR, or in Medford, another Oregon community, you will see it on 
your paycheck. If you are a cop or a nurse, no tax relief for you, but 
if you make over $250,000--on a tax that is used to help strengthen 
Medicare's finances, at a time when we are having this demographic 
revolution--the relief goes to people right at the top, and you reduce 
the life expectancy of the trust fund for 3 years.
  The first thing I will say with respect to what this means, the 
provision I have just outlined breaks a clear promise made by then-
Candidate Trump not to harm Medicare.
  I remember these commercials--we all saw scores and scores of them--
Candidate Trump said to America's older people--many of whom voted for 
him, I think, to a great extent because they heard this promise--he 
said: You know, you have worked hard for your Medicare. We are not 
going to touch it. We are not going to mess with it.
  When the President was asked about cutting Medicare, here is what he 
said: Medicare is a program that works. People love Medicare, and it is 
unfair to them. I am going to fix it and make it better, but I am not 
going to cut it.
  The President of the United States said he is not going to cut it.
  Well, that promise not to harm Medicare lasted 6\1/2\ weeks into the 
Trump administration so the wealthy--the wealthy--could get a tax 
reduction, the fortunate few who need it least, and

[[Page S1721]]

the effect would be to cut by 3 years the life of the Medicare trust 
fund.
  I think that ought to be pretty infuriating and concerning for people 
who work hard--cops and nurses and people who are 50, 55, 60 today. 
They are counting on Medicare to be around when they retire, but 
because TrumpCare made it a focus to give tax relief to the fortunate 
few, that tax relief cuts 3 years off the life of the Medicare trust 
fund.
  If that wasn't enough, people who are 50, 55, 60, before Medicare, 
they are going to get another gut punch. This one is in the form of 
higher costs.
  In parts of my home State--particularly in rural areas like Grant 
County, Union County, and Lake County--I am sure I am going to hear 
about this. I have townhall meetings in each one of my counties. A 60-
year-old who makes $30,000 a year--now those are the people we have 
long been concerned about, particularly people between 55 and 65 
because they are not yet eligible for Medicare.
  A 60-year-old, in communities like I just mentioned, who makes 
$30,000 a year, could see their costs go up $8,000 or more. The reason 
that is the case is a big part of TrumpCare. It is based on something 
we call an age tax.

  Back in the day when I was the director of the Oregon Gray Panthers--
and I was really so fortunate at a young age to be the director of the 
group for close to 7 years--we couldn't imagine something like the hit 
on vulnerable older people that this age tax levies. Republicans want 
to give the insurance companies the green light to charge older 
Americans five times as much as they charge younger Americans. The 
reality is that older people are going to pay a lot more under 
TrumpCare. That is what we were trying to prevent all those years with 
the Gray Panthers. We didn't want to see older people pay more for 
their healthcare, the way they are going to under TrumpCare if they are 
50 or 55 or 60.
  I think the real question is whether they are going to be able to 
afford insurance at all. The reality is that a lot of those older 
people whom I have just described--and I have met them at my townhall 
meetings--every single week they are walking on an economic tightrope. 
They balance their food costs against their fuel costs and their fuel 
costs against their rent costs. Along comes TrumpCare and pushes them 
off the economic tightrope where they just won't be able to pay the 
bills, particularly older people in rural areas.
  So the reality is that it is expensive to get older in America, and 
we ought to be providing tools to help older people. But what TrumpCare 
does is, instead of giving tools to older people to try to hold down 
the costs, TrumpCare basically empties the toolbox of assistance and 
basically makes older people pay more.
  Next, I want to turn to the Medicaid nursing home benefit. Working 
with senior citizens, I have seen so many older people--the people who 
are on an economic tightrope, who are scrimping and saving--even as 
they forego anything that wouldn't be essential, burn through their 
savings. So when it is time to pay for nursing home care, they have to 
turn to Medicaid. The Medicaid Program picks up the bill for two out of 
every three seniors in nursing homes.
  Now, today the Medicaid nursing home benefit comes with a guarantee. 
I want to emphasize that it is a guarantee that our country's older 
people will be taken care of. All of those folks--the grandparents whom 
we started working for in those Gray Panther days--had an assurance 
that grandparents wouldn't be kicked out on the street. TrumpCare ends 
that guarantee.
  You could have State programs forced into slashing nursing home 
budgets. You could see nursing homes shut down and the lives of older 
people uprooted. We could, in my view, have our grandparents that are 
depending on this kind of benefit get nickeled and dimed for the basics 
in home care that they have relied on.
  When it comes to Medicaid, TrumpCare effectively ends the program as 
it exists today, shredding the healthcare safety net in America. It 
doesn't only affect older people in nursing homes. It puts an 
expiration date--a time stamp--on the Medicaid coverage that millions 
of Americans got through the Affordable Care Act. For many of those 
vulnerable persons, it was the first time they had health insurance. So 
what TrumpCare is going to come along and do is to put a cap on that 
Medicaid budget and just squeeze them down until vulnerable persons' 
healthcare is at risk.
  If low-income Americans lose their coverage through Medicaid, it is a 
good bet that the only TrumpCare plans they will be able to afford are 
going to be worth less than a Trump University degree.
  I want to move next to the effects of the bill on opioid abuse. 
Clearly, by these huge cuts to Medicaid, TrumpCare is going to make 
America's epidemic of prescription drug abuse-related deaths even 
worse. Medicaid is a major source of coverage for mental health and 
substance use disorder treatment, particularly after the Affordable 
Care Act, but this bill takes away coverage from millions who need it. 
We have had Republican State lawmakers speaking out about this issue as 
well as several Members of the majority in the Congress.
  Colleagues, just about every major healthcare organization is telling 
the Congress not to go forward with the TrumpCare bill--physicians, 
hospitals, AARP--that is just the beginning. But the majority is just 
charging forward, rushing to get this done as quickly as possible.
  We are going to have more to say about these issues.
  I see my colleagues here.
  To close, just by intertwining, how this appointment is going to be a 
key part of the discussion of TrumpCare revolves around the questions 
we asked Ms. Verma.
  For example, I was trying to see if this bill would do anything to 
help older people hold down the cost of medicine. Now we have heard the 
new President talk about how he has all kinds of ideas about 
controlling the cost of medicine. Here was a bill that could have done 
something about it.
  I see my colleagues, Senator Stabenow and Senator Cantwell.
  I said to the nominee: I would be interested in any idea you have--
any idea you have--to hold down the cost of medicine. On this side we 
have plenty of ideas. We want to make sure that Medicare could bargain 
to hold down the cost of medicine. We have been interested in policy to 
allow for the importation of medicine. We said: Let's lift the veil of 
secrecy on pharmaceutical prices.
  I asked Ms. Verma: How about one idea--just one--that you would be 
interested in that would help older people with their medicine costs. 
She wouldn't give us one example.
  I am going to go through more of those kinds of questions, because 
the reality is--and I see Senators Stabenow and Cantwell here--that 
what we got in the committee was essentially healthcare happy talk. 
Every time we would ask a question, she would say: I am for the 
patients; I want to make sure everybody gets good care.
  So I thank my colleagues, and I yield for Senator Cantwell.

  The PRESIDING OFFICER. The Senator from Washington.
  Ms. CANTWELL. Mr. President, will the Senator yield for a question?
  Mr. WYDEN. Of course.
  Ms. CANTWELL. Mr. President, I ask this of my colleague, the Senator 
from Oregon, because Washington, Oregon, and so many other States spend 
so much time innovating. The proposal we are seeing coming out of the 
House of Representatives really isn't innovation. I like to say that if 
you are looking at this, just at the specifics, the per capita cap is 
really just a budget mechanism. It doesn't have anything to do with 
innovation. It just has to do with basically triggering a cut to 
Medicaid and shifting that cost to the States. My concern is that we 
already do a lot with a lot less, and we know how to innovate. We would 
prefer that the rest of the country follow that same model. I would ask 
the Senator from Oregon: Do you see any innovation in this model, in 
capping and cutting the amount of Medicaid and shifting that to the 
States?
  Mr. WYDEN. My colleague from Washington is ever logical.
  When I looked at this, I thought of it as an innovation desert 
because I was looking for some new, fresh ideas. We have seen some of 
them from Senator Cantwell's State, and I think the Senator from 
Washington makes a very

[[Page S1722]]

important point with that poster because the reality is that this is a 
cap. This is a limit on what States are going to get. As I touched on 
in my comments, I think what is going to happen is this cap is not 
going to be enough money for the needs. I think this is going to slash 
the help for nursing home care under Medicaid, which pays two-thirds of 
the bill, and I think the nursing home care under this flawed TrumpCare 
proposal is going to get nickeled and dimed.
  My colleague from Washington is right. I tried to read section by 
section, and we have read it several times. But we wanted to make sure 
to look--to my colleague's point--for innovation, and this proposal is 
an innovation desert.
  Ms. CANTWELL. I ask the Senator from Oregon this through the 
Presiding Officer. The innovation that was already in the Affordable 
Care Act really did address the Medicaid population, in which so much 
of that cost is for long-term care and nursing home care. So Medicaid 
equals long-term care for so many Americans. In the Affordable Care Act 
we accelerated the process of shifting the cost to community-based care 
because it is more convenient for patients and up to one-third of the 
cost of a nursing home. So if we keep more people in their homes, that 
is better innovation.
  In the Affordable Care Act, we incentivized States. In fact, we had 
21 States take us up on that--including Arkansas, Connecticut, Georgia, 
Iowa, Kentucky, Louisiana, New Hampshire, Texas, Ohio, Nevada, 
Nebraska. There are many States that are doing this innovation and 
basically trying to move the Medicaid population to community-based 
care so we can save money.
  Savings from rebalancing could make up for a large portion of the 
money the House is trying to cut in this bill. Basically, they are not 
saving the money. They are shifting the burden to the States, instead 
of giving innovative solutions to people to have community-based care; 
that is, long-term care services and staying in their home longer. Who 
doesn't want to stay in their home longer? Then we support them through 
community-based delivery of long-term healthcare services, and we save 
the Nation billions of dollars.
  In fact, our State did this over a 15-year period of time, and we 
saved $2.7 billion. That is the kind of innovation we would like to 
see. But instead of implementing the innovation we started in the 
Affordable Care Act, they are trying to cap the Medicaid funding, which 
basically is changing the relationship from a mutually supported State 
and Federal partnership to a capped federal block grant. They are just 
saying: We are going to cost-shift this burden to you the States.
  I saw that the Center on Budget and Policy Priorities analyzed the 
current House proposal and found it would result in a $387 billion cost 
shift to the States. Does the Senator from Oregon think that Oregon has 
the kind of money to take its percentage of that $370 billion?
  To my colleague from Michigan: Does the Senator think the State of 
Michigan has the dollars to take care of that Medicaid population with 
that level of a cut?
  Ms. STABENOW. If I might lend my voice on this and thank both of my 
colleagues. Senator Cantwell has been the leader in so many ways on 
innovation in the healthcare system as we debated next to each other in 
the Finance Committee on the Affordable Care Act.
  I wanted to share that in Michigan, where we expanded Medicaid, 
because of changes that have been made and work that is being done in 
the budget going forward in the new year, there is now close to $500 
million more in the State of Michigan budget than was there before 
because of Medicaid expansion and the ability to manage healthcare 
risk. People have more healthcare coverage. We actually have 97 percent 
of the children in Michigan who can see a doctor today, which is 
incredible. At the same time the State is going to save close to $500 
million in the coming year's budget.
  Mr. WYDEN. If I can add this, because I think my colleagues are 
making a very important point. If you look at the demographics, there 
are going to be 10,000 people turning 65 every day for years and years 
to come. Senators Stabenow and Cantwell are making a point about 
flexibility. The reality is, if I look at the demographic picture, we 
are going to need more out of a lot of care options--institutional 
care, community-based coverage. But I think the point Senator Cantwell 
started us on is that, at a time when we have a demographic where we 
are going to need more for a variety of care options--a continuum of 
care--what my State is basically saying is that we are going to get 
less of everything. There is going to be less money for the older 
people who have nursing home needs. I am looking at a new document from 
the Oregon Department of Human Services, and it indicates that we are 
going to lose substantial amounts--something like $150 million for 
community-based kinds of services. So I appreciate the point my two 
colleagues are making.
  Ms. CANTWELL. Mr. President, if I could, I will ask the Senator from 
Oregon one more question, and maybe my other colleagues will join in.
  When you do not realize the savings and you cost-shift to the States, 
some of the key populations that you hurt are pregnant women and 
children. We do not want to have less money. If you think about 
Medicaid, pregnant women and children are a big part of the population.
  I know our colleague from Pennsylvania has joined us, and he has been 
a champion for the Children's Health Insurance Program--CHIP--and 
everything that we do for women and children. I don't know if he has 
seen this in his State. I don't know if the Senator from Oregon or the 
Senator from Michigan or the Senator from Pennsylvania wants to comment 
on this--on the notion that we are not realizing the savings from 
delivery innovations like rebalancing, and then figuring out how to 
best utilize those for the delivery of the services that so many people 
are counting on. With a per capita cap, you are really going to be 
starting in a very bad place with the people who need these resources 
the most, and when it comes to Medicaid, women and children are front 
and center in this debate.
  I hate the fact that somebody is going to cost-shift to the States, 
that the States are not going to have enough money, and then the very 
people who would end up paying the price are the women and children. I 
don't know if the Senator from Oregon, the Senator from Michigan, or 
the Senator from Pennsylvania wants to comment on that.
  Ms. STABENOW. I thank the Senator very much. I will say this briefly 
and then turn to our colleague from Pennsylvania, who has been such a 
champion for children.
  I would say first--again, as I said a moment ago--that, because of 
Medicaid, because of the healthcare expansion, 97 percent of the 
children in Michigan now can see a doctor. That means moms who are 
pregnant and babies, and moms and dads are less likely to be going to 
bed at night and saying: Please, God, do not let the kids get sick, 
because they can actually go to a doctor.
  It reminds me, though, of the other thing happening on the floor and 
the larger question of the nominee for the Centers for Medicare and 
Medicaid Services. In the larger context, I asked her about whether or 
not maternity care and prenatal care should be covered as a basic 
healthcare requirement for women. I mean, it is pretty basic for us. 
She wouldn't answer the question. Essentially, she said women can buy 
extra if they want it. The new Secretary of Health and Human Services 
said that we, as women, can buy extra coverage for basic healthcare 
coverage for us. So it all comes together--Medicaid, the nominee on the 
floor, and what the House is doing to take away maternity care. It is 
really just bad news for moms and babies.
  Mr. WYDEN. I would only add that what we learned in our hearings and 
in our discussion is that women, particularly the women served by the 
Medicaid Program, are really dealing with the consequences of opioid 
addiction as well.
  In our part of the world, I would say to Senator Stabenow and Senator 
Casey--in Oregon and Washington--we feel like we have been hit with a 
wrecking ball with this opioid problem. Again, when Senator Cantwell 
talks about shifting the costs, she is not talking about something 
abstract. This

[[Page S1723]]

is going to take away money for opioid treatment.
  So I am very pleased that my colleague is making these points, and I 
look forward to the presentation.
  Mr. CASEY. Mr. President, I thank Senator Cantwell for raising the 
issue about the impact of this decision that the Congress will make 
with regard to a particular healthcare bill and then also, 
particularly, the Medicaid consequences.
  I was just looking at what is a 2-page report that was just produced 
today and that I was just handed from the Center on Budget and Policy 
Priorities. It is State specific.
  In this case, looking at the data from Pennsylvania--I will not go 
through all of the data on Medicaid--just imagine that three different 
groups of Americans have benefited tremendously from the Medicaid 
Program every day. That is why what is happening in the House is of 
great concern to us.
  We have in Pennsylvania, for example--just in the number of 
Pennsylvanians who have a disability--722,000 Pennsylvanians with 
disabilities who rely upon Medical Assistance for their medical care. 
Medical Assistance is our State program that is in partnership with 
Medicaid. There are 261,000 Pennsylvania seniors who get their 
healthcare through Medicaid. Hundreds and hundreds of thousands of 
people who happen to be over the age of 65 or who happen to have a 
disability of one kind or another are totally reliant, on most days, on 
Medicaid. The third group, of course, is the children, and 33 percent 
of all of the births in Pennsylvania are births that are paid for 
through Medicaid.
  When we talk about this bill that is being considered in the House or 
when we talk about the confirmation vote for the Administrator for the 
Centers for Medicare and Medicaid Services, this is real life. What 
happens to this legislation and what happens on this nomination is 
about real life for people who have very little in the way of a bright 
future if we allow some here to do what they would like to do, 
apparently, to Medicaid.
  It sounds very benign to say that you want to cap something or that 
you want to block-grant. They are fairly benign terms. They are 
devastating in their impact, and we cannot allow it to happen. That is 
why this debate is so critical.
  I have more to say, but I do commend and salute the work by Senator 
Cantwell, Senator Stabenow, and Senator Wyden in fighting these 
battles.
  I will read just portions of a letter that I received from a mom in 
Coatesville, in Southeast Pennsylvania, about her son, Rowan. The mom's 
name is Pam. She wrote to us about her son, who is on the autism 
spectrum. In this case, she is talking about the benefits of Medicaid--
Medical Assistance we call it in Pennsylvania.
  Here is what she wrote in talking about the benefits that he 
receives. After he was enrolled in the program, she said that Rowan had 
the benefit of having a behavioral specialist consultant. That is one 
expert who was helping Rowan, who was really struggling at one point. A 
second professional they had helping him was a therapeutic staff 
support worker. So there was real expertise to help a 5-year-old child 
get through life with autism.
  Here is what his mom Pam wrote in talking about, since he was 
enrolled, how much he has benefited and how much he has grown and 
progressed:

       He benefited immensely from the CREATE program by the Child 
     Guidance Resource Centers, [which is a local program in 
     Coatesville]. Thankfully, it is covered in full by Medicaid.

  She goes on to write the following, and I will conclude with this:

       Without Medicaid, I am confident I could not work full time 
     to support our family. We would be bankrupt, and my son would 
     go without the therapies he sincerely needs.

  Here is how Pam concludes the letter. She asks me, as her 
representative--as her Senator--to think about her and her family when 
we are deliberating about a nomination like this and about healthcare 
legislation.
  She writes:

       Please think of us when you are making these decisions. 
     Please think about my 9-month-old daughter, Luna, who smiles 
     and laughs at her brother, Rowan, daily. She will have to 
     care for Rowan later in life after we are gone. Overall, we 
     are desperately in need of Rowan's Medical Assistance and 
     would be devastated if we lost these benefits.

  This is real life for people. Sometimes it is far too easy here in 
Washington for people to debate as if these things are theoretical--
that if you just cut a program or cap a program or block-grant a 
program, you are just kind of moving numbers around and moving policy 
around. This is of great consequence to these families, and we have to 
remember that when we are making decisions around here.
  Everyone who works in this building as an employee of the Federal 
Government gets healthcare. We do not have someone else around the 
country who is debating whether or not we are going to have healthcare, 
like those families on Medicaid are having to endure.
  I thank the Senator from Washington. I know that Senator Stabenow 
from Michigan may have more to add on this. We have a big battle ahead, 
but this is a battle that is not only worth fighting, but it is 
absolutely essential that we win the battle to protect and support 
Medicaid.
  Ms. STABENOW. Mr. President, as Senator Wyden's colloquy comes to an 
end, I will make a few comments in addition to those of my colleagues, 
and I very much appreciate all of their work.
  There are so many different things to talk about as it relates to how 
healthcare impacts people. As Senator Casey said, this is very 
personal; it is not political. There are a lot of politics around this, 
but it is very, very personal.
  In Michigan, when we are talking about healthcare, in Medicaid alone 
we are talking about 650,000 people who have been able to get coverage 
now. Most of them are working in minimum wage jobs, and they now are 
able to get healthcare but couldn't before, as well as their children. 
That adds to the majority of seniors who are in nursing homes now, 
folks getting long-term care, folks getting help for Alzheimer's and 
other challenges and who are relying on Medicaid healthcare to be able 
to cover their costs.
  I want to share a letter, as well, from Wendy, a pediatric nurse 
practitioner from Oakland County in Michigan. We have received so many 
letters--I am so grateful for that--and emails.
  She writes:

       As a pediatric nurse practitioner, I have seen so many of 
     my patients benefit from the Affordable Care Act. Physical 
     exams for the kids are now covered in full, with no co-pay. 
     This means the kids are in to see us, which means we catch 
     healthcare issues and early problems with growth or 
     development that otherwise might be undetected and left 
     untreated until it became a much bigger problem.

  Isn't that what we all want for our children, to catch things early?

       Immunizations are covered, which keeps everyone safer. 
     Screening tests are covered, so potential problems are caught 
     while they can still be managed. This better care keeps kids 
     healthier and happier and prevents longer term care costs.

  She goes on to write:

       The Medicaid expansion means even more kids are covered, 
     keeping not only those children healthier but keeping 
     everyone around them healthier. Previously, parents of 
     children who did not have insurance coverage would not seek 
     care until the children were so ill that they could not see 
     another option. Frequently, these children then utilized 
     emergency room care--

  Which, by the way, is the most expensive way to treat health 
problems--

     [it was] not only a missed opportunity for complete and 
     preventative healthcare but at a cost passed on to the 
     community.
       On a much more personal level, in 2015, our granddaughter, 
     at age 3, was diagnosed with epilepsy related to a genetic 
     condition . . . which made her brain form abnormally. On top 
     of the epilepsy, she has developmental delays and autism, all 
     related to her double cortex syndrome. Although our daughter 
     and son-in-law are fully employed (teacher and paramedic), 
     she qualifies for Children's Special Health Care (under 
     Medicaid). This has been a huge blessing for us, and without 
     it our family would have been financially devastated.
       We are hopeful that my granddaughter will continue to have 
     good seizure control and will develop to reach her full 
     potential, but without the care that her private insurance 
     and Children's Special Health Care provides, she would not 
     have much of a chance of getting anywhere near her potential. 
     I do not want to even consider how it will affect her future 
     if insurance companies can refuse to cover her care due to 
     her preexisting condition.

  She concludes:

       Please do not let partisan politics take precedence over 
     doing what is right and what is best for the health of every 
     U.S. citizen.

  I know we are all getting hundreds of thousands of letters and emails 
and phone calls of very similar stories because healthcare is personal 
to each of

[[Page S1724]]

us--to our children, our grandchildren, our moms, and dads, and 
grandpas and grandmas. It is not political.
  I am very grateful for my colleagues' being here today. I want to 
speak not only about the importance of expansion under Medicaid but 
also about the person who would be in charge of that very, very 
important set of services. That is the nomination in front of us, that 
of Seema Verma to be the Administrator of the Centers for Medicare and 
Medicaid Services.
  This is a critical position, especially given the ongoing efforts 
that we are seeing right now to repeal healthcare--the Affordable Care 
Act--and replace it with legislation that would literally rip away 
coverage for millions of people and pull the thread that unravels our 
entire healthcare system. The decisions of the Administrator, both as 
an adviser to the President and as someone with the authority to make 
large changes in the implementation of existing law, will have far-
ranging consequences for all of us--certainly, for the people whom we 
represent and especially for those who need healthcare, have begun 
receiving it, and now may very well see it taken away.
  In the Finance Committee, when I asked Ms. Verma about Medicaid, I 
found that her positions would hurt families in Michigan, would hurt 
seniors in nursing homes, and would hurt children. And looking at her 
long record as a consultant on Medicaid, we know that Mrs. Verma's 
proposals limit healthcare coverage and make it harder to afford 
healthcare coverage, putting insurance companies ahead of patients and 
families once again.
  I am also very concerned about her position on maternity coverage. 
During the hearing, I asked Ms. Verma whether women should get access 
to basic prenatal care and maternity care coverage as the law now 
allows--I am very proud of having authored that provision in the 
Finance Committee--or whether insurance companies should get to choose 
whether to provide basic healthcare coverage for women. I reminded her 
that before the Affordable Care Act, only 12 percent of healthcare 
plans available to somebody going out to buy private insurance offered 
maternity care--the vast majority did not--and that the plans that did 
often charged extra or required waiting periods. Her response indicated 
that coverage of prenatal and maternity care should be optional--
optional. We as women cannot say our healthcare is optional.
  The next CMS Administrator should be able to commit to enforcing the 
law requiring maternity care to be covered and commit to protecting the 
law going forward for women. Being a woman should not be a preexisting 
condition. Getting basic healthcare should not mean we have to buy 
riders or extra coverage because being a woman and the coverage we need 
is somehow not viewed as basic by the insurance company. We have had 
that fight. Women won that fight with the Affordable Care Act. We 
should not go backward.
  I followed up with Ms. Verma, along with many colleagues, but have 
not received a response.
  Over 100 million Americans count on Medicare and Medicaid. They need 
a qualified Administrator who puts their needs first, and I cannot vote 
for a nominee who does not guarantee that she will fight for the 
resources and the healthcare that the people of Michigan count on and 
need.