[Congressional Record Volume 163, Number 41 (Thursday, March 9, 2017)]
[Senate]
[Pages S1724-S1726]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                               TrumpCare

  Finally, I wish to take a moment to talk about the healthcare bill 
that has now come out of committees in the House and will be voted on 
in the House and then coming to us in the Senate. Frankly, let me start 
by saying that this is a mess--it is a mess on process, and it is a 
mess on substance.
  As a member of the Finance Committee, I can tell my colleagues 
firsthand that this was not rammed through the Senate Finance Committee 
when we passed the Affordable Care Act. We had months and months and 
months of hearings, of which I attended every one, I think, and after 
that, the floor debate and that discussion and the discussion in the 
House. We knew what it would cost before we brought it up, by the way, 
which saved a lot of money by doing a better job of managing healthcare 
costs and creating innovation for our providers.
  But the truth is that when we look closely at what is being debated 
in the House, for families in Michigan and across the country, it is 
really a triple whammy: higher costs, less healthcare coverage, and 
more taxes. Overall, it means more money out of your pocket as an 
American citizen, unless you are very wealthy, and it means less 
healthcare. This is not a good deal.
  It cuts taxes for the very wealthy and for insurance companies. It 
gives an opportunity for insurance company execs to get pay increases 
and cuts taxes for pharmaceutical companies. Someone making more than 
$3.7 million a year would save almost $200,000. Let me say that again. 
Someone making more than $3.7 million a year would put $200,000 in 
their pocket as a result of this healthcare bill, TrumpCare. To put 
that in perspective, 96 percent of Michigan taxpayers would not qualify 
for this. Ninety-six percent of everybody in Michigan who gets up every 
day, goes to work, works hard--some take a shower before work, some 
take a shower after work--they are working hard every single day, and 
they would pay more, while the small percentage of those at the very 
top would get $200,000 back in their pockets.
  As I indicated, it provides a tax break for insurance company CEOs to 
get a raise of up to $1 million but increases taxes and healthcare 
costs for the majority of Americans. Middle-class Americans and those 
working to get into the middle class would see tax increases and lose 
healthcare coverage at the same time--such a deal.
  For seniors, this would allow insurance companies to hike rates on 
older Americans by changing the rating system. AARP, a nonpartisan 
organization, has indicated that premiums would increase up to $8,400 
for somebody who is 64 years of age earning $15,000 a year. So they 
earn $15,000 a year, and their premiums could go up by more than half 
of what they are making. To put that in perspective--again, a 
comparison of who wins and loses under this plan--if you are 64 years 
old and earn $15,000 a year, you pay more--$8,400 more. If you are 65 
years of age and earn over $3.5 million a year, you put $200,000 more 
back in your pocket. This is a rip-off for the majority of Americans 
and should not see the light of day.
  On top of that, TrumpCare creates Medicaid vouchers. We have been 
talking with colleagues about the change in Medicaid. What does that 
mean? Well, instead of being a healthcare plan that covers nursing home 
care, whether that is someone who needs very little care or someone who 
has Alzheimer's or other extensive needs, your mom and dad or grandmom 
and granddad would get a voucher, and if it didn't cover the care in 
the nursing home, as it does now, then your family would have to figure 
out a way to make up the difference. We could very possibly have the 
situation we had before the passage of the Affordable Care Act where a 
lot of folks were going bankrupt trying to figure out--you use the 
equity in your home, except because of what happened in the financial 
crisis, you may not have much equity in your home anymore. So you 
try to figure out, how do I make up the difference to help my mom or 
dad or granddad and grandmom in the nursing home? That will be a very 
common discussion, I would guess, if this passes. So turning Medicaid 
into a voucher system would cut nursing home care and healthcare for 
families.

  Let me also say that when there is a healthcare emergency like we had 
in Flint, MI, with 100,000 people being poisoned with lead and over 
9,000 children under the age of 6 with extensive lead poisoning, and we 
had the President and the past administration step in to help those 
children because of the health problems from the lead exposure, that 
would not be possible under this new regime. It will not be possible to 
step in when there is a healthcare emergency for children or for a 
community.
  In Michigan today, 150,000 seniors depend on healthcare through 
Medicaid for long-term care. Three out of five seniors in nursing homes 
in my State--three out of every five seniors--count on Medicaid for 
their long-term care. This radically changes and dismantles that 
healthcare system. We have nearly 1.2 million children in Michigan and 
380,000 people with disabilities who use this system.
  So we have a situation where we would see a radically different

[[Page S1725]]

healthcare system for seniors and additional costs for seniors, which 
is why the AARP is calling this the senior tax. We would see children 
losing their healthcare. We would see insurance companies being put 
back in charge of decisions--decisions about whether women can get 
basic care and what, if any, kind of preexisting condition coverage 
happens. What I have seen is something that doesn't work and is going 
to put more costs back onto families.
  There is mental healthcare and the ability to make sure that if you 
have a healthcare challenge, such as cancer or some other kind of 
challenge, your doctor is going to be able to treat you and give you 
all the care you need, not just a lump sum that the insurance company 
has decided that they are willing to spend. Then there is 
accountability as it relates to how much of your healthcare dollars 
that you spend goes into your medical care. There are a whole range of 
things that have been put in place so that you have more confidence 
that at least you are getting what you are paying for. Those things go 
away and insurance companies are put back in charge. They are given a 
big tax cut. The insurance company execs are given an opportunity for 
big increases in their pay, while everybody else is paying more.
  So let me go back to where I started. TrumpCare, the bill being voted 
on in the House, is really a triple whammy for the people of Michigan: 
higher costs, less coverage, and more taxes. It makes no sense. I will 
strongly oppose it when it comes to the Senate. I am hopeful that we 
can put this aside, stop all of the politics about repeal, and have a 
thoughtful discussion about how we can work together to bring down 
costs and to be able to address concerns to make healthcare better, not 
take it away.
  Thank you, Mr. President.
  The PRESIDING OFFICER (Mr. Cassidy). The Senator from Rhode Island.
  Mr. REED. Mr. President, I rise today in opposition to the nomination 
of Ms. Seema Verma to be Administrator of the Centers for Medicare and 
Medicaid Services, or CMS.
  As a $1 trillion agency with oversight over Medicare, Medicaid, and 
the Children's Health Insurance Program, as well as State health 
insurance marketplaces, CMS is providing affordable health insurance to 
100 million Americans, including nearly half a million Rhode Islanders.
  Given the responsibility that this post entails of ensuring access to 
health care coverage for our most vulnerable citizens, coupled with a 
lack of commitment to fighting back against proposals by this 
administration and some of my colleagues on the other side of the aisle 
to dismantle these programs, I cannot support Ms. Verma's nomination to 
be CMS Administrator.
  CMS is responsible for a key aspect of the Affordable Care Act--the 
health insurance marketplaces--which provide an avenue for all 
consumers to shop for the health insurance options that fit their needs 
and connect consumers with tax credits and subsidies that make the 
coverage affordable.
  President Trump and his new Health and Human Services Secretary Tom 
Price are adamant about repealing the ACA and rolling back these 
benefits. In her confirmation hearing, Ms. Verma was asked multiple 
times to commit to protecting the ACA for the millions of Americans who 
were able to access coverage for the first time because of the law, but 
she would not do so. This, to me, is unacceptable.
  CMS also works with States and other agencies at the Department of 
Health and Human Services to ensure that the plans offered on the 
exchanges are not only affordable but also provide real coverage for 
when it is most needed. I am concerned with Ms. Verma's beliefs about 
what health insurance coverage should look like.
  During her confirmation hearing, she spoke at length about providing 
consumers more choices about their healthcare. Yet she opposes many of 
the protections the ACA provides for consumers. For example, she 
implied that she thought maternity care should be optional. It seems to 
me that for many families, they would be left with the choice to either 
pay for maternity care entirely out-of-pocket--all the while paying 
premiums and copays to the insurance company--or to go without care at 
all. I don't think these are the kinds of choices we should be imposing 
on families.
  Turning my attention to Medicaid for a minute, I am deeply concerned 
about the Republican proposals to fundamentally change Medicaid and 
shift costs to States and to consumers. These proposals aren't new. 
Year after year, Republicans--often under the leadership of then-
Congressman, now-HHS Secretary Tom Price--have proposed block-granting 
Medicaid, cutting the program by hundreds of billions of dollars. While 
Ms. Verma is not yet confirmed, she did express support in her 
confirmation hearing for this very concept--block-granting or capping 
Medicaid spending. Just this week, we saw a new version of this 
proposal, which simply delays cuts to Medicaid until 2020. In my 
opinion, this is just a veiled attempt to help gain support for the 
effort now and then turn around and decimate Medicaid in a few years.
  In my home State of Rhode Island, nearly 300,000 Rhode Islanders 
access healthcare through Medicaid. That is about one-third of our 
population, roughly. That is a significant number for a small State 
like Rhode Island. Let's break down that number to see who would be 
impacted by these across-the-board cuts to Medicaid.
  One out of four children in Rhode Island gets care from Medicaid and 
half of the births in the State are financed through Medicaid. One in 
two Rhode Islanders with disabilities are covered by Medicaid, and 60 
percent of nursing home residents in the State get their care from 
Medicaid. Think about what would happen if this funding is cut--and 
that is the trajectory of the Republican proposals--States would have 
to decide, among these populations, who will get health care, children 
or the elderly in nursing homes, the disabled or other Medicaid 
recipients. If States try to make up the difference, that would result 
in cuts elsewhere, such as education and infrastructure. Indeed, given 
the demands for health care, given the tensions between seniors and 
nursing homes, and children needing care, the States will try their 
best to pull from other areas. What is the next biggest area of State 
expenditure? Education. Now you will have pressure on State education 
budgets. Higher education particularly will be pressured. All of this 
will be the ripple effect from these proposed cuts to Medicaid. And 
make no mistake, when Ms. Verma and my colleagues talk about converting 
Medicaid to a block grant program or capping spending, it is not about 
flexibility for the States, it is about reducing the Federal commitment 
to providing funding to the States.
  Lastly, I am concerned about Ms. Verma's ability to safeguard 
Medicare for our seniors. Over 200,000 Rhode Islanders access care 
through Medicare, a benefit they have worked for and earned over their 
entire careers. I believe Medicare is essential to the quality of life 
for Rhode Island's seniors and for seniors across the country, and 
indeed for the children and families of these seniors. In fact, I 
supported the ACA because it made key improvements to Medicare that 
strengthened its long-term solvency and increased benefits, such as 
closing the prescription drug doughnut hole and eliminating cost-
sharing for preventive services such as cancer screenings.
  Over 15,000 Rhode Islanders saved $14 million on prescription drugs 
in 2015, an average of $912 per beneficiary. In the same year, over 
92,000 Rhode Islanders took advantage of free preventive services, 
representing over 76 percent of the beneficiaries. Repealing the ACA 
means repealing these benefits for seniors and shortening the life of 
the Medicare trust fund by over a decade.
  Unfortunately, Ms. Verma has little to no experience working with 
Medicare, and in her hearing and written responses to questions, she 
appeared to have very little to no familiarity with major aspects of 
Medicare. In her confirmation hearing and accompanying documents, she 
simply has not proven herself to be an effective advocate for 
protecting these earned benefits for our seniors.
  We need an Administrator for CMS who will work to safeguard health 
care coverage for children, seniors, and people with disabilities, who 
will seek to strengthen Medicaid, Medicare, CHIP, and our entire 
healthcare system. For the reasons I have outlined, along with other 
reasons some of my colleagues have raised, Ms. Verma, in my opinion,

[[Page S1726]]

is not up to this task. As such, I will oppose the nomination and 
encourage my colleagues to do the same.
  I yield the floor.
  Mr. President, I request the ability to yield the remainder of my 
postcloture time to Senator Wyden.
  The PRESIDING OFFICER. The Senator has that right.
  Mr. REED. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative 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.