[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.