[Congressional Record Volume 163, Number 50 (Wednesday, March 22, 2017)]
[House]
[Pages H2333-H2340]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                        THE IMPACT OF TRUMPCARE

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 3, 2017, the gentlewoman from Washington (Ms. Jayapal) is 
recognized for 60 minutes as the designee of the minority leader.


                             General Leave

  Ms. JAYAPAL. Mr. Speaker, I ask unanimous consent that all Members 
have 5 legislative days to revise and extend their remarks and include 
extraneous material on the subject of my Special Order.

[[Page H2334]]

  The SPEAKER pro tempore. Is there objection to the request of the 
gentlewoman from Washington?
  There was no objection.
  Ms. JAYAPAL. Mr. Speaker, tomorrow we will be voting on the American 
Health Care Act. We are doing this in spite of the fact that we just 
found out that there is an even more dire and harsh plan. We still have 
not received the Congressional Budget Office's estimates of what that 
plan will do, but we do know that TrumpCare will throw at least 24 
million people off of their health care.
  Tonight, for the next hour, I am proud to help lead our Congressional 
Progressive Caucus Special Order hour with my distinguished members 
from the caucus.
  I yield to the gentlewoman from New Jersey (Mrs. Watson Coleman).
  Mrs. WATSON COLEMAN. Mr. Speaker, as the gentlewoman from New Jersey 
said, my colleagues and I will show and prove our true intentions in 
occupying our seats here in Congress.
  We will have the chance to stand with the 24 million Americans who 
have health coverage thanks to the Affordable Care Act or cosign 
billion-dollar tax cuts to the wealthy. We will have the chance to 
reject the attacks on the health of women and older Americans or force 
Americans to pay more for less. We will have the chance to choose 
between what is best for all or what is best for some. We will choose 
between right and wrong.
  Changes to the current law proposed in the un-American Health Care 
Act, also known as TrumpCare, could result in cuts to benefits, 
increased costs, or reduced coverage for older Americans.
  According to the 2016 Medicare Trustees Report, the Medicare part A 
trust fund is solvent until 2028. This is 11 years longer than 
predicted in 2009, due in large part to the changes made in the ACA.
  Repealing the additional 0.9 percent payroll tax on high-income 
workers, as proposed in this new bill, would remove $117.3 billion from 
the Hospital Insurance Trust Fund over the next 10 years. It would 
hasten the insolvency of Medicare by up to 4 years and diminish 
Medicare's ability to pay for services in the future.
  Additionally, provisions of the un-American Health Care Act that 
create a per capita cap financing structure in the Medicaid program is 
equally dangerous. These provisions would endanger the health, safety, 
and care of millions of individuals who depend on the essential 
services provided through Medicaid.
  The CBO found that the bill would cut Medicaid funding by $880 
billion over 2017 to 2026. Medicare and Medicaid must be protected and 
strengthened for older Americans and future generations.
  Any healthcare legislation presented must take into consideration 
future generations of men and women who will take our seats in this 
Chamber, future generations that will produce our first woman 
President, future generations of women that hopefully will not have to 
fight against men meddling in their healthcare decisions.
  This bill is a war on women, and, quite frankly, there is nothing 
pro-life about it. This bill attacks women's access to reproductive 
health care from every angle, undermining not just contraception access 
and abortion coverage, but also making it much harder for women to 
receive maternity coverage when they do give birth.
  The abortion rate is at a historic low, and most analysts say the 
principal reason is that the ACA made contraception cheaper and easier 
to obtain. The CBO report was all-encompassing, but most strikingly 
pointed out a provision that would undermine Planned Parenthood, a 
critical provider for women's health care.

                              {time}  1615

  This provision would bar women on Medicaid from using their coverage 
to go to Planned Parenthood, immediately resulting in many of these 
women losing access to contraception and leading to closing of clinics 
nationwide.
  The CBO estimated that 15 percent of women living in low-income and 
otherwise underserved areas would lose their access to services to 
prevent pregnancy. In short, local access to reproductive health care 
dries up.
  In short, this is unacceptable. Just as I opened, I am going to 
close. Tomorrow my colleagues and I will show and prove our true 
intentions in occupying our seats here in Congress. We will have the 
chance to stand with the 24 million Americans who have healthcare 
coverage thanks to the Affordable Care Act, or cosign billion-dollar 
tax cuts to the wealthy as proposed under the Trump healthcare bill.
  We will have the chance to reject the attacks on the health of women 
and the working families or force Americans to pay far more for far 
less, and we will have the chance to choose between what is best for 
all or what is best for some. Tomorrow, with the votes cast on this 
bill, we will get the chance to choose between right and wrong.
  Ms. JAYAPAL. Mr. Speaker, I thank Mrs. Watson Coleman for her 
excellent statement.
  Mr. Speaker, it is my great pleasure to yield to the distinguished 
gentleman from Rhode Island (Mr. Cicilline).
  Mr. CICILLINE. Mr. Speaker, I thank the gentlewoman for yielding.
  In a very short number of weeks here in Congress, she has already 
made her mark as a passionate advocate not only for her State, but in 
this important fight to protect access to affordable, quality health 
care, and she has been an extraordinary member of the Judiciary 
Committee. It has been an honor to serve with her, and I thank her for 
yielding and thank her for her great leadership.
  Mr. Speaker, we are here to continue our fight to protect access to 
quality, affordable health care and to defeat TrumpCare.
  TrumpCare will produce higher costs for our constituents, forcing 
families to pay higher premiums, higher deductibles, and higher out-of-
pocket expenses.
  It also will provide less Americans coverage. According to the 
nonpartisan Congressional Budget Office, 24 million Americans will lose 
their health insurance when TrumpCare becomes law.
  Thirdly, it imposes a crushing age tax. TrumpCare allows individuals 
age 50 to 64 to pay premiums five times higher than others pay for 
health care, no matter how healthy they are.
  It is higher premiums, higher deductibles, higher out-of-pocket 
expenses, 24 million people will lose insurance, older people will pay 
an age tax. And TrumpCare, in addition to all of those terrible things, 
shortens the life of the Medicare trust fund by 3 years and ransacks 
the funds that seniors depend on, particularly, to get their long-term 
care. And finally, the best estimates are that it will destroy nearly 2 
million jobs in this country if passed.
  So why is this happening? Why would someone construct a bill that 
does this?
  Well, in large part, it is to finance an extraordinarily big tax cut, 
a tax cut for the wealthiest people in this country. The richest 400 
families will receive a tax cut, each, of about $7 million. Then there 
are tax cuts for drug companies, insurance company CEOs.
  And to finance this tax cut, which totals $600 billion over the 
decade, in order to finance that, this bill robs 24 million Americans 
of health insurance, cheats seniors out of the care that they deserve 
in nursing homes, imposes higher premiums and higher deductibles on 
working families, and imposes a crushing age tax on older Americans. 
This is wrong.
  And, you know, the President ran on a campaign of helping working 
people and being for the middle class. This piece of legislation is a 
gift to the richest people in this country and the most powerful 
special interests and a betrayal of the promise to work for middle 
class and working families.
  I want to end, with the indulgence of the gentlewoman from 
Washington, you know, we talk about these numbers, and they are 
staggering: 24 million, $600 billion. Behind each of those numbers are 
real people whose lives will be affected by TrumpCare and by the repeal 
of the Affordable Care Act, individuals whose lives will be devastated, 
families who will be ruined because they no longer have access to the 
care that they need. In the richest, most powerful country in the 
world, this does not have to be the case, and I want to give you two 
examples.
  Just this week I heard from Sara from, Woonsocket, Rhode Island. She 
wrote to me:


[[Page H2335]]


  

       I am writing to you to encourage you to vote against the 
     American Health Care Act proposed by Paul Ryan and the 
     Republican Party. My brother has developmental disabilities 
     and relies on Medicaid for insurance.
       Experts who have reviewed this bill have determined that it 
     will ultimately cut funding for people like my brother, but 
     the working class in this country cannot afford the burden 
     that this bill would impose. And the wealthiest among us do 
     not need any more handouts from the Federal Government.
       Please vote against this bill.

  I had correspondence, again, with another constituent, who talks 
about the important services that the ACA provided to her family. She 
was heartbroken at the death of her son Anthony who passed away on 
August 9 due to an overdose, and she describes Anthony as a 
compassionate and deep person who, unfortunately, like many Americans, 
suffered from severe anxiety and depression. To deal with his 
condition, he started self-medicating with prescription drugs. After 
returning home from a sober house, he, unfortunately, relapsed and took 
some designer drugs that he had ordered online, causing him to 
overdoes.
  She called me just this week. Anthony's sister Cara also suffers from 
anxiety and depression, in part because of the post-traumatic stress 
disorder that she suffered after discovering her brother who had died. 
Thanks to the ACA, she is able to receive coverage for critical mental 
health services since her mother doesn't have coverage through her 
employer.

  Like many of my constituents, Cara relies on the coverage she has 
gained, and she writes:

       I am worried for my future without my support system. The 
     discontinuation of coverage would be detrimental to our 
     efforts to combat mental health disorders and the opioid 
     epidemic which continues to plague families and has been such 
     a support to my family.

  These are just two examples. We have millions of examples all across 
this country of people whose lives have been protected and saved and 
helped because of access to quality, affordable health care. This will 
undo all of that progress. We have to do everything we can to stop it.
  Mr. Speaker, I thank the gentlewoman for yielding and for leading 
this Special Order hour tonight so we can continue to make sure the 
voices of the American people are heard and we defeat TrumpCare and 
protect access to affordable, quality health care in this country.
  Ms. JAYAPAL. Mr. Speaker, I thank my good friend from Rhode Island 
for his incredible leadership on so many issues and for reminding us 
again that 24 million is just a number, but behind that number are all 
of the people and all of the stories that will be impacted.
  Mr. Speaker, now it is my great honor to yield to the gentlewoman 
from California (Ms. Judy Chu), my good friend, the chair of the Asian 
Pacific American Caucus here in the House.
  Ms. JUDY CHU of California. Mr. Speaker, I rise today to voice my 
strong opposition to the American Health Care Act, or TrumpCare.
  TrumpCare would result in 24 million people losing healthcare 
coverage. In my Pasadena, California, district, nearly 70,000 people 
will lose coverage. In Los Angeles County, about 1 million people will 
lose the coverage they have through Medicaid expansion.
  Worst of all, this bill would result in skyrocketing healthcare 
costs, especially for older Americans. It would hurt people like my 
constituent Patty from Claremont. Patty is 62 and never had to worry 
about health care because her husband was a union member with a good 
job, but in one moment, Patty's life was turned upside down.
  Last September, Patty's husband passed away, suddenly. In the blink 
of an eye, Patty was forced to find new insurance for herself and her 
20-year-old son who suffers from a preexisting condition. She couldn't 
afford COBRA and is a few years away from being eligible for Medicare.
  Well, thank goodness the ACA came along and she was finally able to 
get affordable healthcare insurance. She was so relieved.
  But what will happen to Patty's insurance under TrumpCare? We only 
have to look at the CBO's estimate that a 64-year-old making $26,500 a 
year could see their health insurance premiums skyrocket from $1,700 a 
year to $14,600. That amounts to over half their income.
  For Patty, these changes could mean thousands in out-of-pocket 
expenses for her hypertension medication, which she needs to take 
consistently or face life-threatening consequences. Patty would face a 
situation that so many older Americans would face: premiums that would 
rise by 20 to 25 percent by 2026. The premiums rise because, in this 
bill, the GOP created an age tax which allows older Americans to be 
charged five times more than younger Americans.
  Now, in this bill, there is no concrete plan to help older Americans 
like Patty deal with the rising cost of premiums under TrumpCare. And 
certainly nothing in this bill will address the enormous deductibles or 
out-of-pocket costs that they will face if insurance companies can once 
again offer substandard plans with limited benefits. You know, so many 
people like Patty are just one accident away from losing coverage.
  Why is she and 24 million other Americans going to suffer so that, in 
this bill, health insurance executives earning over $500,000 can get a 
tax break? so that the wealthy can get $600 billion wealthier? so that 
400 of the Nation's richest families can get a $7 million tax cut every 
year?
  You know, the term ``coverage loss'' isn't some political tool. It 
has real life-threatening consequences for people of all ages and 
incomes across the country.
  The bill before us today has been crafted behind closed doors. We 
have had no hearings on this legislation, and Republicans have not 
accepted a single Democratic amendment to the bill.
  There are just too many American lives at stake. I urge my colleagues 
to oppose TrumpCare.
  Ms. JAYAPAL. I thank the gentlewoman from California.
  Now it is my tremendous honor to introduce and yield to the co-chair 
of the Progressive Caucus, the gentleman from Arizona (Mr. Grijalva), a 
dear friend and somebody that has been on the streets and been a leader 
on so many issues, from immigration reform to healthcare.
  Mr. GRIJALVA. Mr. Speaker, I thank the gentlewoman for not only 
managing the time, but her leadership and great work in Congress.
  Mr. Speaker, I rise to speak about the millions of Americans who will 
suffer under this oxymoron called TrumpCare. This bill will result in 
higher costs and less coverage for hardworking Americans, especially 
the poor and the elderly. The only winners in this bill are the wealthy 
who are getting their $600 billion tax cut.
  Earlier this week, an official with the American College of 
Physicians put it best when he said:

       In 38 years of advocating for doctors and patients, I have 
     never seen a bill that will do more harm than the AHCA.

  This is a powerful statement.
  You know, Mr. Speaker, what I can't figure out is what problem this 
bill is trying to solve. If the Republicans were looking to cover fewer 
people, make insurance more expensive, and give tax cuts to the rich, 
then I guess this Republican bill is the answer.

  Let's take a quick look at what this bill does or, as my Republican 
colleagues refer to it, promises kept.
  First and foremost, 24 million Americans are going to lose coverage. 
Let me repeat that, 24 million. That is not only unacceptable, it is 
cruel.
  And even for those lucky enough not to lose coverage, things are not 
going to be very good.
  Under the Republican healthcare scheme, older Americans will be 
paying five times more. In what world does anyone think that it is a 
good idea to make health care even more expensive for the elderly? This 
is one of those crazy but true things about this bill. So this is what 
the GOP calls promises kept.
  Well, let's take a moment to remember what promises were actually 
made. In an interview with ``60 Minutes'' in 2015, President Trump 
promised:

       Everybody is going to be covered. I am going to take care 
     of everybody. I don't care if it costs me votes or not, 
     everybody is going to be taken care of much better than they 
     are being taken care of now.

  Then just 2 days before the election, Trump went to Sioux City, Iowa, 
and said:

       I am going to protect and save your Social Security and 
     your Medicare. You made a deal a long, long time ago.

[[Page H2336]]

  


                              {time}  1630

  So how does this repeal bill stack up with those promises? Premiums 
will spike 750 percent with far fewer tax credits to help shoulder that 
burden; 30 million Americans with preexisting conditions would lose the 
certainty of coverage they have enjoyed under ObamaCare; Medicare will 
be slashed by $170 billion; Medicaid will be cut 25 percent. That is 
$880 billion being ripped away from the most vulnerable Americans, 
resulting in 14 million people losing coverage immediately.
  So who wins here with TrumpCare? The rich, who will reap $600 billion 
in tax cuts at the expense of medical treatment for the most vulnerable 
and working folks in this country; Big Pharma is a winner who can now 
look forward to more obscene profits and less oversight; and, of 
course, the private health insurance companies, who, once again, will 
be in total charge of America's health care.
  Who loses? Hardworking, regular folks who simply can't afford to 
underwrite a tax cut for the rich at the expense of their health.
  Take my constituent, Shawn, for example. He wrote me to share his ACA 
story. In 2006, Shawn was diagnosed with HIV and a rare heart 
condition, and his premiums skyrocketed from $123 a month in 2005, all 
the way up to $1,473 a month in 2012. That is an average increase of 
between 35 and 40 percent per year. At the same time, his deductible 
climbed to $2,900, meaning his insurance wouldn't offer him a dime 
until he coughed up nearly $3,000 first.
  When ObamaCare kicked in in 2014, Shawn had at least a dozen plans to 
choose from. He selected a platinum plan which delivered better 
coverage than he previously had for only half the price that he had 
previously been paying. Let me repeat: because of ObamaCare, Shawn 
started paying half the price for a better plan. How was it better? As 
Shawn put it, he no longer faced lifetime caps; he had free wellness 
visits included in his coverage; instead of a nearly $3,000 deductible, 
he now had just a small copay.
  If the ACA is repealed, Shawn will be uninsured for the first time in 
his life. For the first time in 54 years, Shawn will be forced to pay 
out of his own pocket for lifesaving medications. His HIV medications 
alone cost nearly $30,000 per year--that is three times as much as he 
pays right now for all of his medical expenses. If he is hospitalized 
for his heart condition--which has occurred already twice--he will 
incur tens of thousands of dollars in additional charges. In short, 
under the Republican's healthcare scheme, Shawn will be financially 
ruined.
  Mr. Speaker, this is utterly unacceptable. The American people 
deserve access to affordable, accessible, and high quality health care. 
TrumpCare achieves the opposite. It is a bad deal and a threat to the 
well-being of our Nation and our people. Beyond that, it is shameful 
and inhumane.
  Mr. Speaker, I urge my colleagues to oppose TrumpCare in its entirety 
and vote it down tomorrow.
  Ms. JAYAPAL. Mr. Speaker, I thank Representative Grijalva.
  I am so proud to introduce my colleague from Massachusetts, 
Representative Joe Kennedy.
  Two weeks ago, during the Energy and Commerce markup on TrumpCare, 
the gentleman actually forced Republican lawmakers to admit that the 
bill--their bill, the TrumpCare bill--would not guarantee essential 
healthcare benefits for the millions who are covered under Medicaid 
expansion, and, later, the gentleman went on to give an incredibly 
compelling speech about this bill not being an act of mercy but being 
an act of malice. I hope that the gentleman is now going to tell the 
American people exactly why he said what he did.
  Mr. Speaker, I yield to the gentleman from the State of Massachusetts 
(Mr. Kennedy).
  Mr. KENNEDY. Mr. Speaker, I want to thank my colleague for adding her 
voice on such an important issue before our country today and for 
leading our efforts here this afternoon on the House floor.
  There are an awful lot of important components to this bill that we 
are debating now and that will supposedly come before us tomorrow 
afternoon. One of the critical pieces of it is how we are going to 
treat people suffering from mental illness.
  Now, the bill itself does a number of things across insurance 
marketplaces and across Medicaid and Medicaid expansion, but I think it 
is critically important that we look at this through the framework of 
what health care is supposed to be all about. Health care, at least 
from my understanding, boils down to one simple principle. It is how we 
treat each other in our time of need and this commitment that we make 
as a country to each other, that, yes, I care about you and your family 
and want to make sure that you get the care that you need when you need 
it. Because with health care, at some point, I am going to need that 
same care as well: a loved one of mine, my children, my family members, 
and I hope that you would be there for me the same way that I would be 
there for you.
  So if you look at this bill through that prism, one of the pieces 
that stands out is the fact that, for the Medicaid expansion 
population, about 11 million people across our country, this bill 
strips what is called the essential healthcare benefits from those 11 
million people. Now, that is a bureaucratic term, but it means some of 
the most basic aspects of health care: maternal care and newborn care, 
preventive services, wellness, ambulatory care, and, yes, mental health 
services and addiction, behavioral health.
  So what does that actually mean? It means that because of existing 
legislation, the Federal law, mental health parity, which says that if 
mental health benefits are, in fact, offered as part of a healthcare 
package, insurance package, that it has to be offered in the same way 
that physical health care is. You should treat your access to 
behavioral health care the same way we would treat access to health 
care if you needed cancer treatment or a broken leg. But the mental 
health parity law does not require mental health benefits to be offered 
at all. The Affordable Care Act, however, says that in order for a plan 
to be qualified, it does have to offer an essential health benefits 
package, included in that being access to mental health care.

  So those two laws together work in tandem to have created a massive 
increase in access to behavioral health and mental health services, 
including, critically for the moment that we are in our country, access 
to opioid treatment.
  What this bill does is strip those essential benefits, including 
access to addiction services and mental health care, from that 
essential benefits package and says to the States: Good luck, you can 
pay for them if you want to, providing nowhere near the sufficient 
funding to cover all of the demands that our Republican colleague says 
the funding will be there for.
  Now, to make matters even more convoluted in this, it was clear, 
during the debate in our committee 2 weeks ago for 28 straight hours, 
that some of our colleagues actually thought these protections were 
maintained when we pointed out that, in fact, they were stripped. There 
was then a different version of this bill that was brought forth for 
consideration called the manager's amendment. That manager's amendment 
happened to reinstate those benefits, which was great, and I applaud my 
Republican colleagues for doing so, aside from the fact that they then 
realized that they included those benefits and they offered an 
amendment to strip them back out, just in the past 36 hours, 
recognizing that there was a bill that they thought offered these 
benefits--the package of essential health benefits--for 11 million 
people to begin with, they found out that it didn't, in fact, offer it; 
they fixed it and put them back in a bill, realized they did it 
inadvertently and took it out again and are now laying that bill 
supposedly before our consideration tomorrow.
  If health care is, in fact, that commitment we make to each other in 
our time of need, how does this bill answer that question? The average 
cost of a birth in this country is roughly $10,000. Medicaid itself 
pays for half of the births in our Nation. Maternal care and newborn 
care are covered under the essential health benefits, but not anymore 
for the Medicaid expansion population. For that population, having a 
child could very literally bring you to bankruptcy. That is the bill 
that this Republican Congress is putting forward for your consideration 
tomorrow.

[[Page H2337]]

  That is one of the many reasons why I urge my colleagues to vote 
``no.''
  Ms. JAYAPAL. Mr. Speaker, I thank Representative Kennedy so much. As 
the gentleman was talking, I was thinking about the simple rule that we 
are all better off when we are all better off. I appreciate everything 
that you just said.
  Mr. Speaker, it is a great honor for me to yield to the gentleman 
from the great State of Minnesota (Mr. Nolan).
  Mr. NOLAN. Mr. Speaker, I thank the gentlewoman for that 
introduction.
  I want to thank my colleagues for presenting their profound thoughts 
on this most important legislation that we will consider tomorrow. The 
simple truth is that what this bill does is it removes 24 million 
people and takes them away from having affordable health care and 
health insurance, while, at the same time, giving $600 billion in tax 
cuts for the richest people in America. Some pundits have described it 
as one of the biggest transfers of wealth and travesties perpetuated 
upon the American people in American history.
  I am calling upon the Republicans here in this Chamber and President 
Trump to withdraw this legislation, sit down in a bipartisan way--the 
way this Congress operated for several hundred years under open rules--
and see what we can do to fix what is wrong with the American 
healthcare system, not do away with it and scrap it in the devastating 
manner that they have chosen to do so.
  The simple truth is, as I said, this guts Medicaid, and it guts 
health care. Under this $600 billion tax break, think about it, if you 
make $1 million a year, every year you are going to get a $67,000 a 
year tax cut. Imagine that. That is more money than the average person 
makes in America in a year, and they are going to get that every year 
going forward in perpetuity, while we are saying to a young family who 
is struggling maybe because someone in the family has cancer or maybe 
somebody got hurt or injured in an accident, oh, that is going to cost 
too much money to insure you, you are one of the 24 million who we are 
getting rid of.
  What kind of a country is it that would do something like that? My 
colleague, Mr. Kennedy, I thought, stated it so well. We are all in 
this together. That is what insurance does. Life is perilous at best. 
We don't know who is going to get sick. We don't know who is going to 
have an accident. It may be when you are elderly; it may be when you 
are young. That is what health care and health insurance is all about, 
coming together and making sure that we all are cared for and get the 
care that we need when we need it.

  Senator Kennedy talked about preventive care. If you can catch 
prostate cancer or if you can catch lung cancer at a stage I or a stage 
II level, you save a life. But you have to have insurance to go do that 
and see your doctor. If you don't have insurance, guess what? You don't 
get a diagnosis until it is at the third or fourth stage level, at 
which point it is too late, costs tremendous amounts of money to treat, 
and, most likely, the prospects for survival are not good.
  Mr. Speaker, I call on the President and my colleagues, please, the 
President in particular, honor the promise that you made to the 
American people in your campaign which resonated with enough people to 
get you elected President of the United States. Stand up for the 
elderly, stand up for urban and rural, stand up for all Americans, 
stand up for rural communities, and rural hospitals. Do the right 
thing, and let's open this process up so we can fix what needs fixing 
and stop this devastating attack by repealing and so-called replacing 
the Affordable Care Act.
  Ms. JAYAPAL. Mr. Speaker, I thank the good gentleman from Minnesota 
for his tremendous work and for his words. As the gentleman spoke, I 
think about all the names that we could call this bill that is before 
us. We can call it TrumpCare, we can call it the pay more get less 
bill, and we can call it the broken promises bill. But I think what the 
gentleman's words have shown us is that this is a bill that is going to 
deeply affect 24 million Americans across the country and tear them off 
of their health care, and that is just not acceptable.
  Mr. Speaker, I yield to the gentlewoman from California (Ms. 
Brownley). It is a great honor to introduce my colleague who is a 
champion for so many issues.
  Ms. BROWNLEY of California. Mr. Speaker, I thank the gentlewoman from 
Washington.
  Mr. Speaker, after 7 years of demanding repeal and replace, the very 
best that the GOP could do was to put forward a bill to eliminate 
health care for 24 million Americans. Under TrumpCare, over 44,000 
residents in my district will lose health care completely.

                              {time}  1645

  I want to talk about a different population that we don't address as 
often. Many of these residents are veterans and their families.
  Paralyzed Veterans of America today reminded me that today many vets 
rely on Medicaid for their health care. TrumpCare undermines the safety 
net for our veterans and their dependents and their caregivers.
  According to PVA, the total number of veterans without insurance 
dropped very sharply in recent years, yet TrumpCare cuts more than $800 
billion from the Medicaid program, which many veterans and our military 
families turn to for care. Worse, in their rush to rip health insurance 
away from tens of millions of Americans, the manager's amendment to 
TrumpCare could deny tax credits to millions of military veterans.
  Mr. Speaker, veterans are among those that TrumpCare would hurt. 
There are thousands of veterans in my district and thousands of 
veterans in every district across our great country.
  My colleagues on the other side of the aisle should think long and 
hard before they take this critical, lifesaving care away from those 
who need it most: our veterans who have served our country so bravely 
and so patriotically and whom we have made a solemn promise to.
  Ms. JAYAPAL. Mr. Speaker, I yield to the gentlewoman from Texas (Ms. 
Jackson Lee), my colleague on both the Judiciary Committee and Budget 
Committee and a champion for people of color and folks across this 
country.
  Ms. JACKSON LEE. Mr. Speaker, I am delighted to join the 
Congressional Progressive Caucus, on which I serve as a vice chair. I 
remember this experience less than a decade ago when we worked so hard 
to have the Affordable Care Act.
  For many, you are seeing this poster for the first time. I think I 
need to give you a little journey down memory lane as we talk about why 
we are so vigorously opposing what would seem to be new and fresh 
ideas.
  First of all, let me say the good thing about the Affordable Care Act 
is that it is not a respecter of economic standing as relates to the 
benefits of health insurance. We were able to grant every American the 
right to have insurance that did not penalize you for being a woman, 
penalize you for having a preexisting condition. In fact, it did lower 
premiums.
  We realize that in certain areas that is one of the beginning aspects 
of a bill that is only 7 years old, but one of the important points is 
that we have given you insurance that has more benefits than it ever 
had 10 years ago, 15 years ago. More importantly, working people who 
happen to be of low income and who are no less able or dignified or 
equal in this Nation now have insurance.
  It is insurance. The underpinning of it is Medicaid, but it is 
insurance. It allows families, pregnant women, and children to have 
insurance, people who are working. Then, on the other side, it has help 
for the blind, the disabled, as well for those in nursing homes. 
Remember, people in nursing homes have worked. We give them the ability 
to live in dignity.
  Unfortunately, to the contrary, what I am seeing now, just coming out 
of the Cloakroom, is a hustle and bustle of negotiations and meetings, 
going in and out of meetings, going to the White House, trying to 
corral these last votes. Some of these individuals want it to be made 
worse, and they are holding their ground.
  But I tell you what is missing in all of this. What is missing is 
that what we did almost 10 years ago was have hundreds, maybe 
thousands, of hearings or townhall meetings in our districts. We had 79 
bipartisan hearings in the House, 453 hearings in the Senate. In the 
House, we had over 181 witnesses

[[Page H2338]]

and 239 considered amendments. We believed in listening to the American 
people, many of whom did not understand, but we wanted to get it out.
  In the dark of night, this bill has come. There are amendments coming 
by the day. I will be leaving here and going to the Rules Committee to 
try to understand what is in the bill.
  To the American people, what you can clearly see that is in the bill 
right now is that we are paying more for less. You are getting $880 
billion taken out of the Medicaid that is used to keep people whole 
after they have worked--those in nursing homes, the blind, the 
disabled, or other things that may have occurred--as well as those who 
are taking care of children and who are pregnant women. Twenty-four 
million will lose their insurance right now, today, as that bill is 
passed. Overall, in 2026, 52 million Americans will be uninsured. You 
can't be plainer than that.
  Then what saddens me the most, besides the $880 billion coming out of 
your insurance, they give a $600 billion tax cut to 1 percent of the 
richest Americans, whom I would venture to say, getting $57,000 per 
family, they would say to you: Take it back and help all of America.
  The age tax, if you are 50 to 64, you are paying a penalty--not 85, 
but 50 to 64. They can't get rid of that. How are you going to pass a 
bill that penalizes?
  I have indicated about $880 billion for Medicaid. Then, of course, 
the tax relief for people who do not want it.
  I say that your patriotism today is letting this see the light of 
day. Let's debate it and discuss it. Let's talk to States like Kentucky 
and West Virginia and those States that have taken expanded Medicaid. 
Let's talk to families, like I have just done today, with children who 
are only being taken care of with their catastrophic illnesses, with 
smiles on their face, and homebound, because they have Medicaid as 
their insurance.
  That is why we oppose the TrumpCare bill. No matter how many backdoor 
meetings President 45 can take care of--I wish, maybe, it started 
earlier, before he attacked President Obama. But, in any event, with 
all of these meetings, we are still at a point where we don't know what 
the bill is doing for people that is good, but we do know what it is 
taking away from people. I just ask that we stop and do this right to 
save lives.
  I thank the gentlewoman for her leadership.
  Ms. JAYAPAL. Mr. Speaker, I yield to my colleague from the District 
of Columbia (Ms. Norton).
  Ms. NORTON. Mr. Speaker, I thank my good friend for the excellent job 
she is doing in leading this Special Order.
  I don't know about you, but the uninsured in my district are down to 
3.8 percent. If you think I am going to let the Republicans take away 
near universal health care from my district, the District of Columbia, 
without a fight, just watch me, and watch my colleagues.
  We had a healthcare townhall. Unlike some of the townhalls of my 
colleagues, there were not people jumping up saying: Why are you taking 
away my health care? Instead, they were people like Debbie.
  Debbie is a lifetime sufferer of asthma. She also has diabetes. She 
reached her cap. That meant that the medicine she was on, which cost 
$10,000 a month, would have to be paid by her. She worked every day. 
How many of you--how many of us--could pay $10,000 a month, no matter 
what job we have? That, along with her diabetes, makes her a paradigm 
of the kind of person whose life and death depends on this bill.
  I want to just say a few words not about all of the important 
information you have had, but about what I call the worst of the worst.
  First, let me congratulate my Republican colleagues on doubling down 
on the number without health care because you double the number without 
health care. As we are rising with the number who have health care, you 
now turn downward. We can't possibly live with that, and I don't think 
the American people will allow you to get away with it.
  I think about our hospitals, and people say: Why should we pay any 
attention to the hospitals? Well, when we get back in the era of 
uncompensated care, what you will have is the Federal Government will 
never compensate your hospital, so you will compensate your hospital. 
We are back in the era of free health care, except there is no such 
thing as free health care. You and I will be paying for it out of our 
pockets.
  What they do to the tax credits is shameful. Flat tax credits, 
unrelated to the costs, replace the kind of tax credits we have in the 
Affordable Care Act, which are just, as you might expect, up and down 
according to the value of insurance.
  What good is a flat tax credit unrelated to the cost of insurance or 
to your income? Do my Republican colleagues really think they are going 
to fool anybody with those kinds of replacements?
  What is perhaps worst of the worst is the work requirement. You get 
sick, you can't afford to work, you have got to be on the Affordable 
Care Act, and you need Medicaid in order to do it. They tell you that 
you have got to go to work in order to--while you are sick, I guess--
get your Medicaid. Get sick, go to work, and qualify for health care 
under the Republican plan.
  Those are just some of the worst of the worst. I have got a whole 
list here, but I thought it important to focus on who gets hurt and 
why, and why we are simply not going to let that happen.
  Ms. JAYAPAL. Mr. Speaker, Ms. Norton is right: the uninsured rate in 
my home State of Washington got cut more than half. So we are down to 
not quite as low as you, but 5.6, I think now, compared to over 13 
percent before the Affordable Care Act.
  I often get to co-chair this Special Order hour with my good friend, 
a brilliant colleague. Mr. Speaker, I yield to the gentleman from great 
State of Maryland (Mr. Raskin).
  Mr. RASKIN. Mr. Speaker, I thank Congresswoman Jayapal for her 
leadership on this Special Order.
  I think the message is getting through to the American people: 24 
million of us are about to lose health care if this legislation goes 
through.
  In my home State of Maryland, 375,000 people are estimated to be on 
the chopping block in terms of their health insurance. In my district, 
the Eighth Congressional District--Montgomery, Frederick, and Carroll 
Counties--we could have 75,000 or 80,000 people lose their health care.
  We were able to cut the uninsured rate in half with passage of the 
Affordable Care Act 7 years ago, and now they want to turn the clock 
back and take us in exactly the wrong direction.
  If a foreign power like Russia, for example, tried to throw 24 
million Americans off of their health care, we would consider it an act 
of sabotage, aggression, and war, but this is something that is 
happening inside the country. Nobody knows why they want to do that to 
older people with this age tax, why they want to do it to children, to 
people who have special health needs, to the sick.
  It is also getting through that there is going to be $600 billion 
that travels upwards in America through a tax break to the wealthiest 
Americans. That is $600 billion that is moving upwards. This is not a 
healthcare plan, primarily. It is a wealth transfer plan, while we toss 
millions of our co-citizens to the curbside.
  Seven years ago, we passed the Affordable Care Act. Millions of 
Americans have gotten health care for the first time, dramatically 
improving public health in lots of different ways, making sure that 
people could not be denied insurance coverage because of a preexisting 
condition, making sure that people in their twenties could stay on 
their parents' plan, ending lifetime insurance limits, ending annual 
limits, requiring insurance plans to pay for preventive services like 
flu shots and cancer screenings and mammograms, dramatically improving 
the public health. This has been a great success.
  Tom Paine once said you cannot ``make a man unknow his knowledge, or 
unthink his thoughts.'' The American people know that we have made 
dramatic progress under the Affordable Care Act. We need to be moving 
more in the direction of covering more people and improving quality and 
reducing people's premiums and copays and deductibles.
  This legislation, the repeal nightmare, goes in exactly the wrong 
direction. It jacks up everybody's premiums, increases the copays and

[[Page H2339]]

deductibles, while throwing millions of people to the sidelines.

                              {time}  1700

  I want to make one final point, which is the message has gotten 
through. The public opinion polls are showing that the American people 
are turning sharply against this terrible repeal plan, which means here 
in Congress the organizers of the plan are getting increasingly 
desperate, and they are making deals.
  One of the deals that they have made with some upstate Republicans 
apparently is colloquially known around here as the Buffalo bribe or 
the Kinderhook kickback or the Hudson hustle. Someone called it today 
the Empire State enticement or simply Niagara calls.
  There are some Republicans in upstate New York who are very nervous 
about voting for this bill, so what they have extracted is a promise, a 
very special provision that doesn't apply to the other 49 States. It 
applies only in New York, and it would say that New York State alone 
cannot assess its counties to participate financially in the Medicaid 
system. There are lots of other States that do it, but only New York 
could not do it. It could not assess the counties, except it could 
assess any jurisdiction with more than 5 million people.
  Gee, what do you think that is? Maybe New York City.
  Now, the problem with this other than it being sordid and unseemly--
this Buffalo bribery, this Hudson hustle--is that it is 
unconstitutional because the Federal Government can try to persuade 
States to do something by offering money, but it cannot extract a 
concession through coercion, and it cannot treat one State differently 
from every other State. It violates the principle of equal sovereignty.
  I would just say, Congresswoman Jayapal, this legislation is not only 
reactionary, taking us back to a past nobody wants to go back to, and 
not only dangerous, but it is also unconstitutional because of the 
Buffalo bribe that is built into it.
  Ms. JAYAPAL. Mr. Speaker, once again, it looks like we need to school 
our colleagues on the Constitution. I thank Mr. Raskin for consistently 
doing that.
  Now it is a great honor to yield to the gentlewoman from Connecticut 
(Ms. DeLauro), the dean of the congressional delegation, a champion for 
women and families, paid leave, and health care across our country.
  Ms. DeLAURO. Mr. Speaker, I am so honored to join my colleagues here 
tonight. I thank the gentlewoman for taking the lead in this effort.
  There really is such an urgency to this debate and to what is 
happening on the floor of this House. I rise to voice my opposition to 
the repeal of the Affordable Care Act, but the urgency of the debate is 
because tomorrow, in this Chamber, in the people's House, House 
Republicans are prepared to vote on a healthcare plan which is 
supported by President Trump and by Speaker Paul Ryan.
  What is at stake on this vote tomorrow in this House? What happens to 
people in this country with this vote tomorrow?
  There is real clarity here. We will see families pay higher premiums 
and higher deductibles. This plan will increase out-of-pocket costs to 
working Americans. In addition to that, older Americans will be faced 
with what has been described as an age tax. Those Americans who are 50 
to 64 years old will pay premiums five times higher than what others 
pay for health coverage, no matter how healthy they are.
  There will be less coverage because we are going to take away health 
care for 24 million hardworking Americans. And for older Americans, 
once again, something that they rely on in terms of healthcare coverage 
is what happens to Medicare. Well, Medicare and the trust fund for 
Medicare will have a shortened life by 2 or 3 years because it takes 
$170 billion from the Medicare trust fund.
  To do what? What does all of this mean? Who benefits from this 
legislation that my Republican colleagues want to pass tomorrow and who 
are strong-arming their own Members to vote for it? Who benefits?
  Don't take my word for it, but the Joint Committee on Taxation 
estimates that two of the tax breaks in the repeal bill will give a 
$275 billion tax cut to individuals with incomes over $200,000; $190 
billion in tax cuts for insurance companies and drug companies who are 
making a fortune, for medical device manufacturers who are making a 
fortune.
  And so what is the balance?
  It is working Americans, older Americans who are going to pay 
increased costs for premiums and deductibles, and the wealthiest 
corporations and individuals are going to get a $600 billion tax cut.
  I will make one final comment because this is where the values of 
this Nation come into play, and when you think about a young woman in 
my district, Mnikesa Whitaker. She is 36 years old. She has an 
autoimmune disease known as scleroderma. She cannot breathe without an 
oxygen tank. She cannot work any longer at 36 years old. What she says 
to me is, without the Affordable Care Act, each day is one day less in 
her life. We cannot let the Mnikesa Whitakers all over this Nation down 
in order to be able to take care of tax cuts for the wealthiest 
Americans and increase the costs to working Americans and older 
Americans.
  We have an opportunity to say no tomorrow and defeat this Republican 
healthcare plan supported by the President and the Speaker of this 
House, which will only do great damage to the health care of the people 
of this great Nation.
  Ms. JAYAPAL. Mr. Speaker, I thank my good colleague from Connecticut 
so much for that incredibly compelling testimony of why we cannot let 
this bill pass.
  Let me summarize what you heard in this last hour from Members across 
our country who are terrified. Frankly, this plan--TrumpCare, the pay 
more get less plan, the broken promises plan--might actually pass. We 
have to make sure that it does not pass.
  So, in summary, TrumpCare strips healthcare coverage from 24 million 
Americans. It cuts $880 billion--that is almost a trillion dollars--
from Medicaid expansion, and it gives $600 billion in tax breaks to the 
wealthiest Americans and corporations while cutting benefits for 
seniors, working families, and the most vulnerable among us.

  Frankly, we don't know everything it does because there have been 
amendments after amendments that have been passed today. We still don't 
know what the full impact of this bill is, yet they are pushing through 
a vote tomorrow if they can get enough votes to pass it.
  TrumpCare is going to raise the cost of health care by about $14,000 
for those between the ages of 50 and 64. That is the age tax you have 
heard about on the floor tonight. And it is going to raise premiums for 
almost everyone. It puts a 30 percent penalty for getting health care 
to anyone who suffers any kind of a catastrophic event that throws you 
off of health care. If you lose your job and somehow you end up without 
health care for a couple months, you are going to have to pay 30 
percent more in order to get your health care back.
  You heard from Representative Kennedy about mental health, you heard 
from Representative Eleanor Holmes Norton about work requirements, and 
that is just a piece of what this TrumpCare bill does.
  Tomorrow I will join my Democratic colleagues and hopefully enough 
Republican colleagues who know that our job is to make sure we provide 
health care for everyone across this country. Tomorrow I will vote 
``no'' for the 24 million people who will lose their coverage. I will 
vote ``no'' for the almost 15 million people who will lose their 
coverage under Medicaid expansion alone. I will vote ``no'' for the 
millions of low-income women who rely on services from Planned 
Parenthood. I will vote ``no'' for the tens of thousands of people who 
will literally die each year if the Republicans succeed in repealing 
the health care that we have now.
  Let's be clear that the Republican majority has been passing 
legislation and voting to repeal the Affordable Care Act for 7 years, 
yet they could not come up with a plan that would, in fact, do what 
they promised, which is to make sure that we are covering more 
Americans at lower prices. As my friend, Representative Raskin, said, 
this is not a healthcare plan. A

[[Page H2340]]

healthcare plan would cover more people. This is a tax plan to take the 
benefits that working families were receiving on healthcare coverage 
across the country and convert it into tax benefits for the wealthiest, 
$600 billion in tax benefits.
  People around the country are calling in to say if you care about the 
American people and if you care about providing health care for all of 
us, this is a bad plan, you should not vote for it. And Republicans are 
hopefully listening to constituents across the country, to their 
Governors in Republican States, Republican Governors who have said how 
much Medicaid expansion has helped their States. They have asked and 
pleaded for people to keep what we have; to make it better, yes, but 
not to strip $880 billion away.
  Just recently, Paul Ryan, the Speaker of our House, was quoted as 
saying that he has been dreaming about yanking health care away from 
the people who need it the most since he was ``drinking at a keg.''
  This is what he said: ``So Medicaid, sending it back to the states, 
capping its growth rate, we've been dreaming of this since I have been 
around--since you and I were drinking at the keg. . . .''
  Well, I don't know what he was thinking about when he was drinking at 
the keg, but I can tell you that what we have been dreaming about as 
Democrats, as people who care about the health care of people across 
this country is that we cover people, that we don't put anyone in a 
position where they are one healthcare crisis away from bankruptcy, 
that we make sure that kids can get asthma inhalers, that we make sure 
that grandma and grandpa can go into the nursing home and get the care 
that they need. If we pass this bill tomorrow, those grandparents are 
not going to have the care that they need. Nursing homes are going to 
shut down. We are going to take away jobs from rural areas, rural 
hospitals across this country.
  Mr. Speaker, today, as we close this Progressive Caucus Special Order 
hour, I say to my colleagues on the other side of the aisle that I 
believe we all have the interests of the American people at heart, and 
if we do, then I hope we will stop this TrumpCare bill from moving 
forward tomorrow.
  Mr. Speaker, I yield back the balance of my time.

                          ____________________