[Congressional Record Volume 163, Number 41 (Thursday, March 9, 2017)]
[Senate]
[Pages S1726-S1728]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                               TrumpCare

  Mr. WYDEN. Mr. President, here we are, with our colleagues on their 
way home, and I thought it would be helpful to take a minute and give 
an assessment of where the TrumpCare debate is at this point because we 
have seen the two major committees in the House act. Some $300 billion 
was slashed from safety net health programs, while insurance company 
executives making over $500,000 annually were given a juicy tax break 
as a bonus.
  To put this into perspective, this tax break that the insurance 
companies' CEOs seem to have after two committees in the other body 
have acted on TrumpCare--the amount of the bonuses for the insurance 
company executives would be enough to cover the TrumpCare-created 
shortfall in Oregon's community-based services for the elderly and the 
disabled two or three times over.
  What we are talking about is how hundreds of billions of dollars in 
tax breaks are going to the fortunate few and special interests, while 
some of the money is coming from stealing a chunk of those dollars from 
the Medicare trust fund. And this is very much intertwined with the 
nominee's work because she would be overseeing Medicare payments to 
rural hospitals in places like Louisiana and Oregon.
  What I am going to turn to now is what TrumpCare, based on these two 
committees, means for rural areas. And, of course, it repeals the 
Medicaid expansion. It caps the Medicaid Program. In my own view, and I 
know the Senator from Louisiana knows a lot about healthcare, in rural 
communities--and most of our towns are under 10,000 in population. I am 
from southeast Portland. I love southeast Portland. The only regret is 
I didn't get to play for the Portland Trail Blazers. Most of the 
communities in our State are under 10,000 in population. As the Senator 
from Louisiana knows, we are talking about critical access facilities. 
We are talking about sole community hospitals. We are talking about the 
facilities that deal with acute care.
  During the last major break over the President's holiday, I started 
what is going to be a yearlong effort for me, and I called it the rural 
healthcare listening tour. It is eye-popping to have those rural 
healthcare providers who in my State have worked so hard to find ways 
to get beyond turf and battles, to work together--the hospitals, the 
doctors, the community health centers, and the like. They have built an 
extraordinary effort that helps to wring more value out of scarce 
dollars. Their programs are based on quality, not on volume.
  By the way, they are a huge source of economic growth and jobs for 
our rural communities. I spent the President's Day recess, and the next 
major recess as well getting out and listening to them. The verdict 
from Oregon's healthcare providers, who have worked very hard at being 
innovative, trying to make better use of what are called nontraditional 
services, said these kinds of cuts are not an option if you want to 
meet the needs of so many who have signed up as a result of the 
Medicaid expansion.
  TrumpCare ends the Medicaid expansion, rolling back Federal matching 
funds in 2020. The rural hospitals in my State are frequently the only 
healthcare provider available for hundreds of miles. The Medicaid 
expansion helped these hospitals keep their doors open.
  I don't think it is hard to calculate why the hospitals are speaking 
out against the flood approach of TrumpCare. They have a lot of 
facilities in rural areas that are already on tight margins. If these 
communities lose the ability to cover needy people, some of the 
essential hospitals--and I just described three types of them--are 
going to have to close, and the reality is going to be that patients 
aren't going to have any doctor anywhere nearby.
  Understand, if the majority insists on ramrodding TrumpCare through--
and at this point we have, I believe--staff just told me that there 
aren't any budget estimates. As of now, the Congressional Budget Office 
is tasked with providing accurate assessments of the budget 
implications. There are not any budget implications.
  So here is the latest. It comes from media that I think is not 
considered by many Trump supporters to be a purveyor of fake news. This 
comes from FOX News. They said: Unknown in the new healthcare plan, 
unknown in TrumpCare--the cost. How many lose or gain insurance?
  I am very pleased that my colleague from New Hampshire has come to 
join me because some of this, I would say to my friend from New 
Hampshire, leaves you incredulous because this comes from FOX News. FOX 
News is hardly a source for what many Trump supporters would consider 
fake news. FOX News is asking the question because they are saying it 
is unknown. It is unknown in the new healthcare plan, Senator Shaheen, 
according to FOX News. The cost is unknown, and how many lose or gain 
insurance is unknown.
  I would say to my colleagues, because my friend from Louisiana has 
joined the Finance Committee, and I remember welcoming him and Senator 
McCaskill, our new members. My colleague from Louisiana is a physician 
and is very knowledgeable about these issues. I don't know how you have 
a real healthcare debate in America--and I have been working on this 
since I was director of the Gray Panthers at home back in the days when 
I had a full head of hair and rugged good looks. When we would start a 
debate, nobody would consider starting it without having an idea of 
costs or how many lose or gain insurance. How much more basic, I say to 
Senator Shaheen, does it get than that? Are these ``gotcha'' questions? 
Are these alternative facts? Are these people who are hostile to 
conservatives? I think not. FOX News--unknown in the new healthcare 
plan.
  I have been outlining what this means in terms of the transfer of 
wealth from working families in New Hampshire and Oregon to the most 
fortunate in our country--people who make $250,000 or more. They are 
actually going to be the only people in America who get their Medicare 
tax cut. So you have this enormous transfer of wealth, what I call the 
reverse Robin Hood: taking from the working people and giving to the 
fortunate few.
  After two committees have now acted in the other body--two committees 
have acted--FOX News says the big questions are outstanding. The 
Senator from New Hampshire knows a lot about rural healthcare. I was 
just outlining to my colleagues what this means for critical access 
hospitals, sole community hospitals, acute care facilities. These are 
the centerpieces of many rural communities, the essence of rural life. 
You can't have rural life without rural healthcare.
  Here we are on Thursday afternoon--with many of our colleagues out 
there tackling jet exhaust fumes heading home--and the big questions, 
according to FOX News, are outstanding.
  I am very pleased the Senator is here. As usual, she is very prompt 
and appreciated.
  I look forward to her remarks.
  The PRESIDING OFFICER. The Senator from New Hampshire.
  Mrs. SHAHEEN. Mr. President, before my colleague from Oregon leaves, 
I want to ask him a question.
  I am reminded, in 2009 and 2010, as we were working on the Affordable 
Care Act, that the HELP Committee held 14 bipartisan roundtables, 13 
bipartisan hearings, 20 bipartisan walkthroughs on healthcare reform. 
The HELP Committee then considered nearly 300 amendments and accepted 
more than 160 Republican amendments, and the Finance Committee--where 
my colleague is the ranking member--held 17 roundtables, summits, and 
hearings on the topic. The Finance Committee also held 13 member 
meetings and walkthroughs, 38 meetings and negotiations, for a total of 
53 meetings on

[[Page S1727]]

healthcare reform. During its process, the Finance Committee adopted 11 
Republican amendments.
  Don't you find it particularly ironic that we are seeing this 
TrumpCare legislation being pushed through on the House side--and what 
we are hearing, the rumors about what is going to happen in the Senate 
is it is not going to have any hearings and it is going to be brought 
to the floor and we are expected to vote on it without having a chance 
for the public to know what is in it.
  Mr. WYDEN. My colleague is making a very important point. I think we 
all know the Senate budget process is a lot of complicated lingo. 
People in the coffee shops in New Hampshire and Oregon don't follow all 
the fine points of reconciliation.
  As the Senator has just said, what they are using is a process that 
is known as reconciliation. That is the most partisan process you can 
come up with. There is no more partisan kind of process, and we were 
talking about the tally. As of this afternoon, two committees in the 
House have acted.
  The Senator from New Hampshire just mentioned, I think, there were 11 
Republican amendments in just one of the committees.
  Mrs. SHAHEEN. Right.
  Mr. WYDEN. As of this afternoon at 4, after hours and hours of 
debate, I am of the impression that not a single significant Democratic 
amendment has been adopted--so the Senator's point of highlighting the 
difference in the process, where we had all of the hearings and all of 
the opportunities that you have to have to get a good, bipartisan bill.
  As my colleague knows, I don't take a backseat to anybody in terms of 
bipartisan approaches in healthcare. I have worked with Republicans--
Chairman Hatch, chronic care. Senator Bennet and I worked on a bill 
with eight Democrats and eight Republicans. I appreciate your making 
this point.
  As of this afternoon, as far as I can tell, no Democratic amendment 
has been adopted. You highlighted 11 Republican amendments getting 
adopted in just one committee. As we indicated, FOX News--not exactly 
hostile to some of the ideas being advanced by the majority--has 
certainly called them out on this.
  Mrs. SHAHEEN. I appreciate the eloquent comments from the Senator 
from Oregon and all of his efforts to make sure we don't take away 
healthcare for so many people who desperately need it.
  That is why I came to the floor today, because I spent the week we 
were back home--not last week but the week before--talking to 
constituents in New Hampshire and listening to what their concerns 
were.
  What I heard was that people were deeply, deeply concerned and very 
upset by the efforts here to repeal the Affordable Care Act, when they 
didn't know what the replacement meant for them. In dozens of 
conversations and roundtable discussions at a townhall forum, Granite 
Staters shared stories of how the Affordable Care Act has been a 
lifeline for them. I heard from people who say their lives have been 
saved by the law.
  In fact, we can see what is at risk in the State of New Hampshire, 
where we have almost 600,000 Granite Staters who have preexisting 
conditions. We have 118,000 people who could lose coverage. We have 
50,000 Granite Staters with marketplace plans who are in the exchange, 
42,000 who are enrolled in Medicaid, and 31,000 who have tax credits 
that lower the cost of healthcare for them. If that is taken away, so 
many of those people have no option for getting healthcare.
  What we know now, after we have finally seen the plan Republican 
leaders are talking about, we know those fears were well founded that 
they were worried they were going to lose their healthcare. What we 
have seen is legislation to repeal the Affordable Care Act that would 
have catastrophic consequences not only for people in New Hampshire but 
for people across this country.
  It is especially distressing that TrumpCare--as it has been 
introduced by the Republicans--would roll back expansion of the 
Medicaid Program, which has, in New Hampshire and across this country, 
been an indispensable tool in our efforts to combat the opioid 
epidemic. In addition, we are seeing, as the Senator from Oregon 
pointed out, that TrumpCare would terminate healthcare subsidies for 
the middle class and for other working Americans, and it would replace 
those subsidies with totally inadequate tax credits--as low as $2,000, 
which doesn't begin to pay for healthcare coverage for an individual, 
much less a family. This means as many as 20 million Americans could 
lose their healthcare coverage.
  Even as the bill makes devastating cuts to the middle class, it gives 
the wealthiest Americans a new tax break worth several hundred thousand 
dollars per taxpayer. I think this proposed legislation is totally out 
of touch with the lives of millions of working Americans, people whose 
health and financial situation would be turned upside down by the bill.
  Last week, in his response to President Trump's address to Congress, 
former Gov. Steve Beshear of Kentucky said something that really 
resonated with me. He reminded us that people who have access to 
healthcare thanks to ObamaCare are ``not aliens from some other 
planet.'' As he described, ``They are our friends and neighbors. . . . 
We sit on the bleachers with them on Friday night. We worship in the 
pews with them on Sunday morning. They're farmers, restaurant workers, 
part-time teachers, nurses' aides, construction workers, 
entrepreneurs,'' and often minimum wage workers. ``And before the 
Affordable Care Act, they woke up every morning and went to work, just 
hoping and praying they wouldn't get sick, because they knew they were 
just one bad diagnosis away from bankruptcy.''
  To understand why people in New Hampshire are so upset and fearful 
about efforts to repeal the Affordable Care Act, we have to look again 
at this chart because some 120,000 Granite Staters could lose their 
health insurance. That is nearly 1 in every 10 people in the State of 
New Hampshire.
  In particular, repeal of the Affordable Care Act would very literally 
have life-or-death consequences for thousands of people who are 
fighting opioid addiction, who have been able to access lifesaving 
treatment thanks to the expansion of Medicaid and the Affordable Care 
Act.
  Sadly, one of the statistics we are not happy about in New Hampshire 
is that we have the second highest rate of per capita drug overdose 
deaths in the country. We trail only West Virginia. The chief medical 
examiner in New Hampshire projects that there were 470 drug-related 
deaths in 2016, including a sharp increase in overdose deaths among 
those who were 19 years old or younger. For a small State like New 
Hampshire, this is a tragedy of staggering proportions, affecting not 
just those who overdose but their families and entire communities.
  I am happy to say, in the last couple of years, we made real progress 
in combating this epidemic because we had the Affordable Care Act and 
its expansion of Medicaid, which has given thousands of Granite Staters 
access to lifesaving treatment. Over the past year, I had a chance to 
visit treatment centers all across New Hampshire. I met with 
individuals who are struggling with substance use disorders and 
providers who are trying to make sure they get the treatment they need.
  Last month, at a center in the Monadnock region of New Hampshire, I 
had an amazing private meeting with more than 30 people in recovery 
from substance use disorders. They are putting their lives back 
together, hoping to reclaim their jobs, to get back with their 
families, and they are able to do that largely because of treatment 
that is made possible by the Affordable Care Act.
  One patient shared her story with me. As with so many others in 
treatment, her story is one of making mistakes, of falling into 
dependency, of struggling with all her might to escape her addiction. 
She is in recovery for the second time, and she said that this time for 
her is a life-or-death situation. She has no family support. She 
worries that she will be homeless when she leaves the treatment 
program, but she is grateful for the Affordable Care Act because it has 
given her one more shot at getting sober and the chance for a positive 
future.
  At a forum in Manchester--New Hampshire's largest city--a courageous 
woman named Ashley Hurteau said

[[Page S1728]]

that access to healthcare as an enrollee in Medicaid expansion was 
critical to her addiction recovery. She had been arrested following the 
overdose death of her husband. Ashley said an understanding police 
officer and a drug court were key to her recovery. She added this:

       I am living proof that, by giving individuals suffering 
     with substance use disorder access to health insurance, we, 
     as a society, are giving people like me the chance to be who 
     we really are again.

  Without that access to treatment, where would Ashley be?
  Several weeks ago I received a letter from Nansie Feeny, who lives in 
Concord, the capital of New Hampshire. She told me the Affordable Care 
Act had saved her son's life. This is what she wrote:

       [My son] Benjamin went to Keene State College with the same 
     hopes and dreams many have when building their American 
     dream. While there he tried heroin. Addiction overcame him 
     but did not stop him from graduating. After graduation he 
     suffered a long road of near death existence. After a couple 
     of episodes where he had to be revived (fentanyl) he chose 
     recovery. And it was due to ObamaCare that we were able to 
     get him insured so he could get the proper help he needed and 
     [into] a suboxone program that assisted him with staying 
     ``clean.''
       In April--

  She wrote, and you could read between the lines how relieved she 
was--

       it will be a year for Ben in his recovery. Without 
     ObamaCare, this would not have been possible. . . . I can't 
     find the words to define my gratitude to President Obama. I 
     believe my son would not be alive today if it were not for 
     this plan that provided the means he needed to get the help 
     he needed at the time he needed it. Ben still has a long road 
     ahead of him but I will see to it that he never walks it 
     alone.

  I also want to share a powerfully moving letter from Melissa Davis, 
an attorney in Plymouth, NH. Ms. Davis writes:

       I am a lawyer who frequently works on behalf of clients who 
     are suffering from substance use disorder, mental health 
     conditions, or a combination of both. I have been working 
     with these clients for over 10 years and I can tell you that 
     access to health insurance has always been the biggest 
     obstacle in obtaining quality and consistent treatment. Since 
     passage of the Affordable Care Act and the expansion of 
     Medicaid, my clients are actually able to access real 
     treatment in ways they never were before. Before the ACA, 
     there were far too many times where my clients were unable to 
     afford private substance use disorder treatment, wait lists 
     at community mental health agencies were extremely long, and 
     AA and NA were not enough. Without treatment, these clients 
     often ended up in jail or worse, dead. I still have clients 
     who face obstacles to obtaining quality treatment, but the 
     ability to get insurance removes a huge obstacle.

  Ms. Davis concludes with this warning:

       I am sincerely afraid for what will happen to my clients 
     and my community if access to quality substance use disorder 
     and mental health treatment is taken away from those people 
     who need it most because they are unable to get insurance. 
     Please do everything you can to save the ACA.

  In dozens of visits to New Hampshire during the campaign, President 
Trump pledged aggressive action to combat the opioid crisis. In his 
address to Congress last week, he once again promised action to expand 
treatment and end the opioid crisis. But despite these bold words and 
big promises, the President's actions have sent a totally different 
signal. His actions threaten an abrupt retreat in the fight against the 
opioid epidemic.
  By embracing the House Republican leadership's plan to repeal the 
Affordable Care Act, President Trump has broken his promise to the 
people of New Hampshire. This misguided bill would roll back the 
expansion of Medicaid, and it could terminate treatment for hundreds of 
thousands of people in New Hampshire and across America who are 
recovering from substance use disorders.
  Meanwhile, the President's nominee to serve as Administrator of the 
Centers for Medicare and Medicaid Services, Seema Verma, has been an 
outspoken advocate of deep cuts to Federal funding for Medicaid. As we 
have seen with so many of the Trump administration nominees, Ms. Verma 
has an underlying hostility to the core mission of the agency that she 
has been asked to lead.
  Seema Verma is currently a health policy consultant who has called 
for less Federal oversight of the Medicaid Program and advocated for 
policies expressly designed to discourage patients from seeking care--
for instance, by imposing cost-sharing burdens on Medicaid recipients. 
In addition, she is a staunch advocate of block-granting Medicaid and 
turning it into a per capita cap system. Over time, this would lead to 
profound cuts to Medicaid, forcing States to raise eligibility 
requirements and terminate coverage for millions of recipients.
  Let's be clear as to who these recipients are. In 2015, the 97 
million Americans covered by Medicaid included 33 million children, 6 
million seniors, and 10 million people with disabilities. Seniors, 
including nursing home costs, account for nearly half of all Medicaid 
expenditures.
  These are some of the most vulnerable people in our society, and they 
will be the targets of Ms. Verma's determined efforts to cut funding 
for Medicaid and terminate coverage for millions of current recipients.
  I also have deep concerns about this nominee's commitment to 
protecting women's healthcare. During her confirmation hearing in the 
Finance Committee, Ms. Verma was asked if women should get access to 
prenatal care and maternity coverage as afforded under the Affordable 
Care Act or whether insurance companies should get to choose whether to 
cover this for women.
  Ms. Verma tried to clarify when she met with me that she hadn't 
really meant what she said. But what she said was that maternity 
coverage should be optional, that women should pay extra for it if they 
want it. Of course, the problem with this position is that it takes us 
backward to the days before the ACA, when only 12 percent of policies 
on the individual insurance market offered maternity coverage.
  In the State of New Hampshire, before the Affordable Care Act, you 
could not buy an individual policy that covered maternity benefits. 
They were not written. Insurers who offered coverage charged exorbitant 
rates with high deductibles, plus benefit caps of only a few thousand 
dollars. This is a major reason why, before the Affordable Care Act, 
women were systematically charged more for health insurance than men. 
In the eyes of insurance companies, being a woman was seen as a 
preexisting condition, and they charged us more accordingly.
  Well, the American people don't want drastic cuts to Medicaid, cuts 
that will threaten coverage for children, for seniors, for people with 
disabilities, and for those receiving treatment for substance use 
disorders. That is why I intend to vote against the confirmation of 
Seema Verma to head CMS.
  In recent years, we have made impressive gains, securing health 
coverage for millions of Americans and significantly improving the 
health of the American people. I can't support a nominee who wants to 
reverse these gains.
  In recent weeks, all of our offices have been flooded with calls, 
with emails, with letters opposing the Trump administration's plans to 
repeal ObamaCare and undermine both the Medicare and Medicaid Programs. 
We need to listen to these voices. We need to keep the Affordable Care 
Act and the expansion of Medicaid.
  There are things we can do to make it better, and we should work 
together to do that. But we have heard from people loud and clear 
across this country. It is time now to respect their wishes, to come 
together to fix this landmark law, and to ensure that it works even 
better for all Americans.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. WYDEN. Mr. President, before my colleague from New Hampshire 
leaves, does she have a quick minute for a question?
  Mrs. SHAHEEN. Absolutely.