[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
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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.