[Congressional Record Volume 163, Number 41 (Thursday, March 9, 2017)]
[Senate]
[Pages S1728-S1730]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                               TrumpCare

  Mr. WYDEN. I thank her for her presentation. It was factual and very 
specific, and I think it really highlighted so many of the concerns 
that we have at this point.
  I want to see if I could get this straight on the opioid issue. Here 
you all are in New Hampshire, right in the center of the Presidential 
campaign. All of the candidates are coming through, and they are 
practically trying to outdo each other in terms of their pledges to 
deal with this wrecking ball that is the opioid addiction that has 
swept through New Hampshire

[[Page S1729]]

and, of course, my own home State as well.
  I remember then-Candidate Trump being particularly strong and 
assertive about how he was going to fight opioids.
  I think what my colleague said--and I am curious, so I am going to 
ask a couple of questions because I don't think folks even in my home 
State are aware of some of these things. So I am going to ask my 
colleague about it.
  Are folks in New Hampshire aware at this point--my colleague put up 
that Trump chart, showing how the people didn't know what was being cut 
and how much it was going to cost and all the rest. Are people in New 
Hampshire at this point aware of the fact that this is essentially 
after a campaign in their home State, which certainly put out a lot of 
TV commercials and campaign rhetoric in the fight on opioids?
  I think my colleague said that when people unpack this, they are 
going to see that this is a major broken promise, that TrumpCare is a 
major broken promise on opioids because, in terms of the time sequence, 
they all had debates and commercials, then we finally got some money in 
order to have treatment.
  And I think what my colleague said is that now, as a result of 
TrumpCare and the cap on Medicaid, there will not be the funds to get 
the treatment to people who are so needy. Is that what this is going to 
be about in New Hampshire?
  Mrs. SHAHEEN. That is absolutely correct.
  I remember meeting one young man early in the fall, in the middle of 
the campaign early last year. He came up to me in Manchester and said: 
I am so worried about what is going to happen in this election because 
I am in recovery; I am an addict. He said: I am worried that whoever 
gets elected is not going to continue to make sure that I can get the 
treatment I need. He said: I am worried about Mr. Trump.
  As my colleague pointed out, Donald Trump, when he was campaigning in 
New Hampshire, made a lot of promises about how he was going to address 
the heroin and opioid epidemic, how he was going to make sure that 
people could get treatment, treatment at a cost they could afford.
  Well, thanks to the Affordable Care Act and the expansion of Medicaid 
and the great work by our Republican legislature and our Democratic 
Governor--then-Governor Hassan, who is now in the Senate--we passed a 
plan to make sure that people who had substance use disorders could get 
treatment.
  Last year we had 48,000 applications submitted under the expansion of 
Medicaid for treatment of substance use disorders. If we pulled the 
plug on that Medicaid expansion so that people couldn't get that 
treatment, they wouldn't have anywhere to go.
  That is what I heard when I was at Phoenix House in Dublin, in the 
western part of New Hampshire, a couple of weeks ago. I was sitting 
around with about 30 people in recovery, people who are hopeful for the 
first time in a long time because they are in treatment and they can 
see they can put their lives back together.
  I said to them: What happens if we no longer have the Medicaid 
Program?
  They said: We don't have any other options. We don't have treatment.
  What we heard from President Trump is that he was going to introduce 
a healthcare plan that was going to cover more people for less money 
and better quality. Well, that is not what we are seeing.
  The TrumpCare that was introduced in the House this week that they 
marked up and that is going to be coming to the Senate doesn't do that. 
It reduces coverage under the Medicaid Program. It would throw 
thousands of people off of their treatment for substance use disorders, 
and there is nowhere else for them to go.
  This is not an acceptable plan. This does not do what the President 
promised he was going to do. It is not what he promised in New 
Hampshire, it is not what he promised in the campaign, and it is not 
what he has promised since he became President.
  Mr. WYDEN. I think my colleague's point is well taken.
  As we have been saying, this is very much intertwined with the Seema 
Verma nomination because what we learned in the committee is, in 
Indiana, where she touts her pioneering work, if somebody had an 
inability to pay for a short period of time, they would be locked out 
of the program. So in terms of Medicaid, this is going to cause a real 
hardship.
  I had already outlined that it is going to cause a hardship in 
another program that is important to New Hampshire, and that is 
Medicare, because we are implementing what is called the MACRA, the new 
reimbursement system for doctors. We asked her questions about rural 
care, and she didn't know the answer either.
  I particularly wanted my colleague to walk us through this situation 
with respect to how New Hampshire residents are going to see TrumpCare 
as it relates to opioid addiction after they have all these grandiose 
promises and the many debates and commercials.
  I thought I would ask if my colleague has time for one other 
question.
  In New Hampshire, as in Oregon, we have a lot of seniors. It looks to 
me as if somebody who is, say, 58 years old or 62 years old is just 
going to get hammered by what we call the age tax because in these 
bills, which are now moving like a freight train with the House already 
moving in two committees, Republicans want to give insurance companies 
a green light to charge older people five times as much as they charge 
younger people. So I cited a number of my small, rural counties--Grant 
County, Union County, Lake County--and how a 60-year-old who makes 
$30,000 a year can see their insurance costs, because of the age tax, 
go up something like $8,000 a year.
  I don't have the numbers as of now--Finance staff is still working on 
that for every single State--but obviously that tax sure looks like it 
is going to hit somebody in New Hampshire, an older person, people 
before they are eligible for Medicare, and particularly in that 55-to-
65 bracket. It looks like it is going to hit them very hard. How is 
that going to be received, because in my time in New Hampshire, we 
talked about it, and a lot of those people really are walking on 
economic tightropes. They are balancing their food bill against their 
fuel bill and their fuel bill against their rent bill. I know my 
colleague spends a lot of time trying to advocate for them, help them 
through small business approaches. How are they going to be able to 
absorb what is clearly going to be thousands of dollars in new out-of-
pocket health costs?
  Mrs. SHAHEEN. I think that is a huge problem. New Hampshire has a 
population that is one of the fastest aging in the country. As Senator 
Wyden points out, not only does the TrumpCare legislation change how 
people on Medicare are charged for their health insurance, but it also 
would change the other aspects of the Affordable Care Act that have 
been beneficial, such as preventive care under Medicare.
  It would also change the effort to close the doughnut hole--the cost 
of the prescription drugs that seniors buy. That has been a huge 
benefit to people in New Hampshire over the last few years because they 
are beginning to see their costs for prescription drugs affected 
positively. So it will have a huge impact on seniors in New Hampshire.
  The other issue that will have an impact not only on seniors but on 
everybody is what will happen to our rural hospitals. In New Hampshire, 
because we have a lot of rural areas in the State, we have a lot of 
small towns. Most of our hospitals are small and rural. They have 
benefitted significantly under the Affordable Care Act because they 
have been able to get paid for people who come to the emergency room 
for treatment. We have gotten a lot of people out of emergency rooms 
and into primary care. Most hospitals have seen about a 40-percent 
decline in people using emergency rooms for their healthcare. That has 
been a huge, important benefit to our rural hospitals that are 
operating on very thin margins that we need to keep open, not just 
because of the healthcare they provide but because of the jobs they 
provide. In most of our small communities, those hospitals are among 
the biggest employers.
  There are huge impacts if we repeal the Affordable Care Act and we 
put in place this TrumpCare policy that doesn't cover as many people. 
It is going to cost more, it is going to reduce the help people are 
getting

[[Page S1730]]

through their healthcare coverage, and it is going to have a 
detrimental impact on people in the State of New Hampshire and across 
this country.
  Mr. WYDEN. I thank my colleague.
  We have heard Republicans say repeatedly that anything they are going 
to do with Medicare is not going to hurt today's enrollees or people 
nearing retirement. The fact is, TrumpCare hurts both. It is going to 
shorten the life expectancy of the Medicare trust fund, and those older 
people--I will be curious, when my colleague returns--I will be very 
interested to hear what seniors in New Hampshire who are 56 to 68 and 
are walking on that economic tightrope are going to say.
  I thank my colleague from New Hampshire for the excellent 
presentation.
  Mrs. SHAHEEN. I thank the Senator, and thank the Senator for his 
fight to help as we try to prevent people across this country from 
losing their healthcare.
  Mr. WYDEN. I thank my colleague, and we are going to prosecute this 
cause together.
  I see that the chairman of the Finance Committee has arrived. He 
graciously said I could take another 5 minutes or so of our time.
  Before we wrap up this part of our presentation, I want to point out 
that we have outlined how people who are dealing with the consequences 
of opioid addiction would be hurt by TrumpCare. We have outlined how 
seniors who are not yet eligible for Medicare are going to be hurt and 
how seniors who are now on Medicare are going to certainly be hurt by 
reducing access to nursing home benefits. Now I would like to wrap up 
by going to the other end of the age spectrum and talk for a moment 
about children.
  Nearly half of Medicaid recipients are kids, and the program of the 
Republicans--now that we have two committees in effect out of chute 
with their proposals--restructures the program in the most arbitrary 
way, using these caps, shifting costs to States. And the reality is 
that Medicaid is a major source of help for children. There is early 
and periodic screening, diagnosis, and treatment benefits. But with 
reduced funding, the States are going to be forced to make difficult 
decisions about which benefits they can keep providing. States are 
going to be forced to reduce payments to providers, particularly for 
kids, providers such as pediatric specialists, and limit access 
to lifesaving specialty care.

  My own sense is that this is shortsighted at best, and it is like 
throwing the evidence about children and their health needs in the 
trash can. Children receiving Medicaid benefits are more likely to 
perform better in school, miss fewer days of school, and pursue higher 
education.
  Before I yield the floor to my good friend and colleague Chairman 
Hatch, I want to come back to what disturbs me the most about all of 
this. All of these dramatic changes to Medicare and Medicaid that strip 
seniors and some of our most vulnerable citizens are being made at the 
cost of hundreds of billions of dollars to these programs while, in 
effect, there is an enormous transfer of wealth given to the most 
fortunate in America in the two bills that were passed by the other 
body today in the committee. In effect, for example, people who make 
over $250,000 will not have to make the additional payments under the 
Medicare tax. If ever there were a group of people in America who 
doesn't need additional tax relief, it is those people.
  As we wrap up this portion of the presentation, I want people to just 
think about looking at their paycheck. Every time you get a paycheck in 
America, there is a line for Medicare tax. Everybody pays it. It is 
particularly important right now because 10,000 people will be turning 
65 every day for years and years to come.
  What the tax provisions of this legislation mean--and they are part 
of hundreds of billions of dollars of tax cuts--for insurance 
executives making over $500,000 annually, there are yet additional 
juicy writeoffs, while seniors and those of modest means are going to 
bear the brunt of those reductions. Nothing illustrates it more than 
cutting the Medicare tax, colleagues.
  I don't know how anyone can go home in any part of the country and 
say: You know, we are going to have to charge older people between 50 
and 65 a lot more for their coverage, and by the way, insurance company 
executives making $500,000 a year are going to get more tax relief. I 
don't think it passes the smell test in America. It is reverse Robin 
Hood. There is no other way to describe it. It is transferring wealth 
from working families and those who are the most vulnerable. When 
working Americans see their paycheck and see the Medicare tax, I hope 
they remember that in this bill, the Medicare tax is reduced for only 
one group of people--people making more than $250,000 a year.
  I want tax reform. The chairman of the Finance Committee knows that. 
I have introduced proposals to do that. But I don't know how we get tax 
reform when they are giving the relief to the people at the top of the 
economic ladder and it is coming out of the pockets of working people 
and working families. Everybody is going to be able to see it right on 
their paycheck, right there with the Medicare tax.
  I think we will continue this debate, but on issue after issue, with 
the nominee on the floor, Ms. Verma, what she will do if confirmed is 
directly related to TrumpCare. For example, we told her in the 
committee that we wanted her to give one example--just one--of an idea 
to hold down pharmaceutical prices, which is something else that is 
important to older people.
  TrumpCare, by the way, could have included proposals to try to help 
hold down the cost of medicine. Guess what, folks. On pharmaceutical 
prices, there is no there, there either. It doesn't do anything to help 
people.
  This vote we will have on Tuesday is the first step in the discussion 
of how this particular nominee would handle the implementation of 
TrumpCare. Her job oversees Medicare payments to hospitals. It is 
really intertwined, this nomination and TrumpCare, and we couldn't get 
any responses to how she meets the needs of working families, as I just 
mentioned, with respect to pharmaceuticals, and we are pretty much in 
the dark with respect to how she would carry out her duties. As of now, 
we don't see how she is going to do much to try to eliminate some of 
the extraordinary harm that is going to be inflicted on the vulnerable 
and seniors on Medicare and Medicaid as a result of TrumpCare.
  I reserve the remainder of my time, and I yield the floor.
  The PRESIDING OFFICER. The Senator from Utah.