[Congressional Record Volume 163, Number 79 (Monday, May 8, 2017)]
[Senate]
[Pages S2788-S2789]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                       Republican Healthcare Bill

  Mr. NELSON. Mr. President, I want to talk as well about the 
Republican healthcare plan and point out why it is moving on very 
treacherous territory when it will affect the funding of Medicaid by 
lessening the amount of Medicaid money that will be spent in the 
States, because so much of that Medicaid money is going to address the 
opioid crisis.
  The opioid crisis, we found last year--you know, there was a lot of 
talk about it being in New Hampshire when the eyes of America were on 
New Hampshire in the New Hampshire primary. But the fact is, it is in 
every State now. It is particularly so in my State of Florida. There 
are something like 2,600 deaths that have occurred in Florida as a 
result of opioid overdoses. So the seriousness with which we are 
addressing this issue ought to be of extreme concern, and we ought to 
be doing something about it. Yet a bill just passed by the House of 
Representatives is doing exactly the opposite. It is going to cut 
Medicaid. It is a fancy term, cutting Medicaid with a block grant. What 
it means is that it is going to be capped. That means a State is not 
going to get any more Medicaid once that cap has been hit, unless the 
State responds. So, in essence, it is going to cost the States more 
money. I don't think you will find many States that are in such a 
fiscal condition that, in fact, they could do that.

  So what are we doing? We are harming poor people and the disabled who 
get their healthcare from Medicare and Medicaid. In fact, we are not 
only harming all of them, but addressing the opioid crisis will be 
particularly hurt.
  What I want to talk about today is the Republican healthcare plan 
that passed out of the House last week. This plan is going to increase 
costs for older Americans. Remember, it is going to go on a ratio. 
Instead of 1 to 3, or older Americans being charged three times as much 
in health insurance as younger Americans, it is going to go up to a 
ratio of at least 1 to 5, and maybe more. So it is going to increase 
costs for older Americans. It is going to cut Medicaid, and it is going 
to take healthcare coverage away from tens of millions of people.
  Right now as a result of the ACA, there are 24 million people who 
have health insurance coverage who did not have it before this law was 
passed in 2010. It is going to reverse that. Do we want to take away 
healthcare from people who can now have healthcare through Medicaid 
and/or health insurance because they can now afford health insurance? 
Is that really a goal the United States wants to do--to take away 
healthcare through private health insurance? I don't think that is what 
we want to do, but that is what the House of Representatives' 
Republican healthcare bill has done.
  If we just look at my State of Florida, there are almost 8 million 
people who have a so-called preexisting condition. This includes 
something as common as asthma. That is a preexisting condition. As a 
former elected insurance commissioner of Florida, I can tell you that 
some insurance companies would use as an excuse as a preexisting 
condition something as simple as a rash and say: Because you have a 
preexisting condition, we are not going to insure you. Under the 
existing law, the Affordable Care Act, an insurance company cannot deny 
you with a preexisting condition. Just in my State alone, there are 
almost 8 million people who have a preexisting condition. Are we going 
to turn them out on the streets because their insurance company says 
they are not going to carry them anymore? I don't think that is what we 
want to do.
  The bill allows insurers to charge older Americans at least five 
times more than what they charge younger adults. Is that what we want 
to do?
  What is the principle of insurance? The principle of insurance is 
that you spread the risk. You get as many people in the pool as you 
can--young, old, sick, healthy--and you spread that risk.
  If you get fire insurance on your home, you are paying a premium 
every month and the insurance company has calculated in an actuarial 
calculation what it is going to cost you to insure, and you are part of 
hundreds of thousands of people in that pool who are also insuring 
against fire damaging their house. It is the same principle with health 
insurance. So you get young and old, sick and well, and some people 
with preexisting conditions, and you spread that risk over a lot of 
people. One of the fallacies we hear is that we can create this by 
creating a high-risk pool. In other words, we are going to set up some 
money for people who have really sick conditions, and we are going to 
take care of them. That is the most inefficient way to do it because 
insurance is about spreading risk, not concentrating risk, which is 
what a high-risk pool exactly is. So the House of Representatives, 
which has concocted this thing called the Republican healthcare plan, 
has come up with exactly the opposite idea of funding--instead of 
spreading the risk, concentrating the risk, and then saying that they 
are going out and getting $8 billion and that is going to pay for it. 
It is not even going to touch it. It is the most inefficient way to 
approach the subject of spreading risk, because they don't spread the 
risk. They concentrate the risk.
  What this bill does is that over 10 years it cuts over $800 billion 
out of Medicaid. You start doing that, and you are going to lose what 
we know of as Medicaid, a healthcare program primarily for the poor and 
the disabled.
  By the way, isn't it interesting that they cut over $800 billion and 
save it out of Medicaid, and what did they do in the same bill? They 
give upwards of $600 billion in tax breaks to those who are at the 
highest income levels. Let me get this right. It is kind of a reversed 
Robin Hood. I am going to take from the poor by cutting $800 billion, 
and I am going to give to the rich by tax breaks for the highest income 
folks. Is that what we want to do? I don't think so.
  Medicaid is a program that guarantees healthcare for millions of 
Americans, including children, people with disabilities, pregnant 
women, and seniors on long-term care. Think about that. What am I 
talking about? It is seniors in long-term care, seniors in nursing 
homes, who don't have enough resources or enough assets in order to pay 
for their care in their twilight years. Therefore, they are being paid 
by Medicaid, and that is the only source of income to take care of 
them. Is that what we want to cut in order to give a tax break for the 
highest income group? It ought to be the reverse. That is upside-down 
thinking.
  Last week the Florida Medical Examiners Commission released new data

[[Page S2789]]

showing that over 2,600 Floridians have died from opioids in just the 
first half of 2016 alone. Over the entire year before, 2015, fentanyl, 
an opioid, killed 705 Floridians. Just in the first half of 2016, 
almost the exact same number, 704, died. We have a problem in the State 
of Florida, and there are a lot of other States that have the same.
  Last month I went to a research institute down in Palm Beach County. 
They are using NIH grant money to research new nonaddictive opioid 
drugs. If they can come up with this, that is certainly all for the 
better to help people with pain and so that they are not being given an 
addictive drug. But we are not there yet, and we are using NIH money 
that is going into that research.
  Last month I sent a letter to the Republican leadership pushing for 
more funding for the opioid fight and for the National Institutes of 
Health, or NIH.
  Mr. President, I ask unanimous consent to have that letter printed in 
the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                         United States Senate,

                                   Washington, DC, April 26, 2017.
     Hon. Mitch McConnell,
     Majority Leader, U.S. Senate,
     Washington, DC.
     Hon. Paul Ryan,
     Speaker, House of Representatives,
     Washington, DC.
       Dear Leader McConnell and Speaker Ryan: As negotiations 
     over the latest stopgap government funding measure continue, 
     we urge you to focus on securing substantial funding in the 
     appropriations legislation currently being negotiated for two 
     of our most essential national priorities: fighting the 
     opioid epidemic and investing in our nation's biomedical 
     research programs.
       Every day, 91 Americans die from an opioid overdose, and 
     despite the tireless work of many in our communities, this 
     public health epidemic is only getting worse. Currently, only 
     10 percent of individuals who need specialty treatment for 
     substance use disorder actually get it--not because we don't 
     know how to help, but in large part because there aren't 
     enough funds to provide these services. We need substantial 
     additional resources to fight this epidemic and fund 
     prevention, treatment, and recovery activities.
       It is also essential that we increase our investment in the 
     National Institutes of Health (NIH), our nation's premier 
     research institution. NIH funding supports innovative, 
     cutting-edge research that plays a critical role in the 
     development of lifesaving cures for diseases. Our ability to 
     fight Alzheimer's disease, diabetes, cancer, heart disease, 
     and many other diseases depends on our willingness to invest 
     in science. While investments in the NIH have consistently 
     produced tremendous value, funding for the NIH has failed to 
     keep pace with inflation over the last several decades.
       It is essential to provide new funding to fight the opioid 
     epidemic and support biomedical research at the NIH. This new 
     funding should not fill in for cuts made elsewhere to opioid 
     and NIH funding. It is also essential that opioid funding be 
     distributed to the communities that need it must and that 
     have been hardest hit by this terrible public health 
     epidemic.
       While past Congresses have made promises about providing 
     states with additional funding to address the ongoing opioid 
     crisis, appropriations legislation like the pending budget 
     deal is where the bill comes due. Americans are counting on 
     Congress to live up to its commitments by supporting funding 
     for the priorities that matter most in their lives. Funding 
     to fight the opioid epidemic and support research into 
     lifesaving cures through the NIH rank at the top of this 
     list, and we urge you to include substantial additional 
     funding for these areas in the appropriations legislation now 
     being negotiated.
           Sincerely,
       Senator Elizabeth Warren, Senator Bill Nelson, Senator 
     Benjamin L. Cardin, Senator Tom Udall, Senator Dianne 
     Feinstein, Senator Debbie Stabenow, Senator Sherrod Brown, 
     Senator Jeanne Shaheen, Senator Al Franken, Senator Richard 
     Blumenthal, Senator Edward J. Markey, Senator Chris Van 
     Hollen, Senator Margaret Wood Hassan, Senator Christopher 
     Murphy, Senator Joe Manchin III, Senator Tammy Baldwin, 
     Senator Cory A. Booker, Senator Tammy Duckworth, Senator 
     Bernard Sanders.

  Mr. NELSON. So what we need to do is to take a comprehensive approach 
to helping our State and local governments respond to this opioid 
epidemic.
  I was very happy to be an early part of putting together and 
sponsoring a bill called the Comprehensive Addiction and Recovery Act 
of 2016 and of the funding included in the 21st Century Cures Act to 
start putting more resources into our States right away for this opioid 
epidemic. Those laws have resulted in Florida's receiving more than $27 
million to help our State respond to the opioid crisis. Yet a lot more 
action is needed, as you can see by just the first half of last year 
alone, with 704 people dying from opioid overdoses.
  Last week, in Florida a local paper reported about how the opioid 
epidemic is affecting our Nation's children. In 2015 alone, 167 babies 
were born in opioid dependency in just one city--Jacksonville--
contributing to Duval County's being tapped as having the second 
highest number of babies born addicted to opioids in the State. Isn't 
that sad that children come into this world and they are already 
addicted?
  We are dealing with people's lives here. We are dealing with their 
health. The last thing in the world we ought to be doing is cutting the 
resources of funding to help people who are in such dire straits. I 
would urge our colleagues to think twice about supporting this 
disastrous Republican healthcare bill.
  I yield the floor.
  I suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. CARDIN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.