[Congressional Record Volume 163, Number 80 (Tuesday, May 9, 2017)]
[Senate]
[Pages S2827-S2829]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                         Healthcare Legislation

  Mr. VAN HOLLEN. Mr. President, I join my colleague in opposing the 
nomination of Dr. Gottlieb and thank him for laying out the case.
  The FDA, of course, is an important part of our healthcare system, 
and just last week we saw the House of Representatives jam through a 
piece of legislation that would wreak havoc on the healthcare system. 
In fact, many people are appropriately calling what they did 
``wealthcare'' because it represents a huge transfer of wealth away 
from caring for patients to the very wealthiest in our country, 
including many powerful special interests.
  I think everybody understands--Republicans, Democrats, Independents 
alike--the Affordable Care Act is not perfect and specifically that we 
need to address the issues within the Affordable Care Act exchanges. We 
need to address those issues to lower the deductibles, lower the 
copays, and make it more affordable. There are some very 
straightforward ways of doing that.
  One good idea is to create a public option within the Affordable Care 
Act exchanges, a Medicare-for-all-type choice. What will that do? It 
will create more competition. That will drive down the price of 
insurance within the Affordable Care Act exchanges, and it will ensure 
that you have a provider everywhere in the United States in every 
community of this country. Even better, the Congressional Budget 
Office, the last time they looked at it, concluded that it would save 
taxpayers $160 billion over 10 years, so it would reduce our deficit.
  The House Republican wealthcare bill doesn't try to fix the 
exchanges. What it does is blow up the Affordable Care Act and in the 
process wreaks havoc on our entire healthcare system. You don't have to 
take my word for it. Just take a look at the long list of groups that 
have come out strongly opposed to the House bill, starting with patient 
advocacy groups, such as the American Lung Association, the American 
Diabetes Association, the American Heart Association, the American 
Cancer Society, and the list goes on. These aren't Democratic groups. 
They don't have only Democratic patients. They have patients who are 
Democrats, Republicans, Independents, and people who aren't 
participating in the political process. These are groups that care 
about patients, they don't care about politics, and they are strongly 
opposed.
  How about those who are providing care to those patients? Well, here 
is a partial list of the groups that are strongly opposed: the American 
Academy of Family Physicians; the American Medical Association, the 
doctors; the American Academy of Pediatrics, the folks who look after 
the care of our kids; the American Nurses' Association.
  Let's look at the hospital groups. The American Hospital Association 
strongly opposes this; the Children's Hospital Association opposes 
this, and the list goes on. It is opposed by those who are spending all 
their time advocating for patients and opposed by those who provide 
care to patients.

  Then you have a long list of senior groups, including AARP, that 
strongly oppose this because the House bill discriminates against older 
Americans--people over 50 years old--because it allows insurance 
companies to charge them a whole lot more for their healthcare than 
they currently have to pay.
  These groups don't care about party. They don't care about politics. 
They care about patients in our healthcare system, and it should tell 
us all a lot that they are opposed and strongly opposed to this bill. 
Now, why is that?

[[Page S2828]]

  This House bill is rotten at its core. Its foundation was rotten when 
the Congressional Budget Office first looked at it, and then they made 
it even worse. Let's look at the foundation of this, which the 
Congressional Budget Office did have a chance to look at. I do want to 
remind the Presiding Officer that the head of the Congressional Budget 
Office was selected by the chairman of the House Republican Budget 
Committee, the House Budget Committee, the Republican chairman, and the 
chairman of the Senate Budget Committee, a Republican chairman. They 
took a look at that first foundation of the House bill, and here is 
what they concluded. This is right in their report; that 24 million 
Americans would lose their access to affordable healthcare. That is on 
page 2 of the nonpartisan Congressional Budget Office report.
  Why is that? It is because they take a wrecking ball to Medicaid and 
a wrecking ball to the exchanges. They don't make the exchanges better. 
They don't drive down the prices. They make the exchanges worse, and 
they take a big whack at Medicaid. In fact, they also take a cut at 
Medicare. In fact, if you go to the table in this CBO chart, I will 
just refer people to table 3. Sometimes you just have to dig deep in 
these reports to get to the bottom line. There is an $883 billion cut 
that consists of about $840 billion cuts to the Medicaid Program, $48 
billion cut to the Medicare Program, and I should emphasize that will 
actually make the Medicare Program somewhat more insolvent. You add it 
up, you have $880 billion in cuts to Medicare and Medicaid combined.
  I remind people that the Medicaid funding not only went to provide 
more access to people for healthcare through expanding Medicaid, which 
many States have talked about and Governor Kasich has been talking 
about recently, but this bill also cuts the core Medicaid Program to 
the States, and two-thirds of that money goes to care for seniors in 
nursing homes and people with disabilities. So it puts all of them at 
risk. That is $880 billion in cuts to Medicaid and Medicare and people 
who need healthcare.
  What is the other big number in the House bill? Well, $900 billion is 
the amount of the tax cuts in what is being described as a healthcare 
bill. That is why people are calling this a wealthcare bill because you 
are cutting $880 billion out of Medicaid and Medicare and transferring 
those dollars that are currently being spent to provide healthcare to 
tens of millions of Americans, transferring that money back primarily 
to the wealthiest people in this country and corporate special 
interests.
  Under this $900 billion tax cut, if you are earning over $1 million a 
year, you are getting an average tax cut of $50,000 a year. If you are 
in the top one-tenth of 1 percent of income earners--we are talking 
about the wealthiest people in this country--you are getting an average 
annual tax cut of $200,000.
  Do you know what they did for insurance companies? They used to say 
the bonuses that were paid to the CEOs of insurance companies would be 
taxed, but they took that away. So now insurance companies can 
essentially pay bonuses and deduct those. They can deduct those now 
from their bottom line, which drives up the profits of insurance 
companies by allowing the deduction of CEO bonuses. So we have $900 
billion in tax cuts that primarily go to the wealthiest, and $880 
billion in cuts to the Medicaid Program and Medicare that goes to care 
for people. That is why this bill is rotten at its core, because it is 
going to hurt our healthcare system, according to all those patient 
advocacy groups and all those patient provider groups, and for what? To 
give this windfall tax break to the wealthy and powerful interests.
  That is why it is probably no surprise that when the American people 
were asked about that original House bill, only 17 percent said: Yes, 
that is a good idea. Everybody else said: Uh-uh, we don't like what we 
are seeing. That is the bill I was just describing.
  Then the House took that rotten foundation and put even worse stuff 
on top of it. They added a provision that would eliminate the essential 
benefits package. These are the provisions that ensure that when you 
are buying an insurance policy, you are getting something that will be 
there when you need it rather than a junk policy--the policies people 
used to get, where they found out after they got sick, ``Uh-uh, we are 
not paying for that,'' said the insurance companies ``because look here 
at the back of page 100, last paragraph, fine print, you are not 
covered for that.'' That is why we had an essential benefits package 
for things like maternity care, mental health care, coverage for 
substance abuse.
  I hear a lot of talk about the problems with the opioid epidemic. 
Those are real problems that are hurting families around the country. 
That was part of the essential health benefits--not there in the House 
bill.
  Then, to add insult to injury, they took out the requirement that you 
have coverage for preexisting conditions in an affordable way. You 
know, people can play word games all they want. You can say that you 
have to provide coverage for someone with preexisting conditions, but 
if the policy you propose is $200,000 a year, $300,000 a year, we all 
know that is a false promise. That is a hoax. That is playing games 
with the American people. So you can write in any kind of requirement 
you want that preexisting conditions be covered, but if they are 
unaffordable, it is not real. That is why the Affordable Care Act put 
everybody into a pool together, to help reduce the costs so we could 
make sure we protected people with preexisting conditions--asthma, 
diabetes or whatever it may be. The House bill pulls the plug on that. 
Maybe that is why the House didn't want to wait for the next 
Congressional Budget Office report to tell them what their bill would 
do to the American people.
  I have already read a little from the original Congressional Budget 
Office report that was based on the foundation of this House bill. That 
hasn't changed. That bill is rotten at its core, and as the 
Congressional Budget Office says, it is going to knock 24 million 
people off of affordable healthcare, going to apply big tax breaks to 
wealthy people, but then they added other provisions as well--getting 
rid of the essential health benefits, getting rid of protections for 
preexisting conditions. Then it was let's see no evil, let's hear no 
evil. We are not even going to wait for the next Congressional Budget 
Office report. I am looking forward to hearing what they have to say.

  For the American people, I think the greatest danger is that here in 
the Senate we are going to hear from a lot of Senators that they don't 
like the House bill just as it is; yes, we are going to have to make 
some changes. What I would say to the American people is to beware of 
people who say they are going to make a change that is meaningful to 
the Affordable Care Act that the House bill passed--their version of 
the bill. Beware of people who say they are making a change that is 
meaningful when it is really only a cosmetic change, when it is really 
only a small change that then provides some kind of rationale or excuse 
for supporting a House bill that is rotten at its core.
  For example, someone may say: Well, let's do a little more by way of 
covering opioid addiction. That would be a good idea. But that doesn't 
salvage a bill that is fundamentally flawed. That doesn't salvage a 
bill that at its core cuts $880 billion from Medicaid and Medicare to 
provide a tax cut of over $900 billion, most of which goes to wealthy 
people and corporate special interests.
  I would say to all the other people who are on employer-provided 
healthcare, which are the majority of Americans: Beware, because that 
House bill will affect you too.
  I just want to read a portion from something that appeared in 
TheUpshot public health section of the New York Times--``G.O.P. Bill 
Could Affect Employer Health Coverage, Too.'' They write:

       About half of all Americans get health coverage through 
     work. The bill would make it easier for employers to increase 
     the amount that employees could be asked to pay in premiums, 
     or to stop offering coverage entirely. It also has the 
     potential to weaken rules against capping worker's benefits 
     or limiting how much employees can be asked to pay in 
     deductibles or co-payments.

  So for someone who is getting coverage through their employer, beware 
because this is going to have harmful effects on you.
  I want to close with one of the many stories that I have received--
and I

[[Page S2829]]

know many of us have received from our constituents--about how that 
House bill would wreak havoc in their lives. Here is one that I 
received:

       I'm 29 years old and was just diagnosed Feb. 24th with 
     breast cancer. . . . I buy insurance myself, and did so with 
     the assistance from the ACA. Without that program in place, I 
     might not have gone in when I felt this lump. I might have 
     waited much longer, just to be told that it was too late. 
     Without this program, I would be bankrupted by the screenings 
     alone just to find out I am dying. . . . Someone told me not 
     to make this political--but this is my life. It will 
     literally be life or death for so many of us.

  This is a life-or-death issue for tens of millions of our fellow 
Americans. I urge the Senate to flatly reject the House healthcare-
wealthcare bill, which is rotten to its core.
  Let's focus on fixing the issues in the exchanges. We can do that if 
people of good faith want to work from scratch to address that issue, 
but let's not blow up the Affordable Care Act and hurt our constituents 
and tens of millions of other Americans in the process.
  I yield the remainder of my time.
  The PRESIDING OFFICER. The Senator from Ohio.
  Mr. BROWN. Mr. President, I particularly appreciate the comments of 
my colleague from Maryland about the Affordable Care Act. The fact is, 
they are taking insurance from 200,000 Ohioans right now who are 
getting opioid treatment because of the Affordable Care Act, and the 
vote in the House of Representatives would turn those 200,000 families 
upside down. They should be ashamed of themselves. Then to go to the 
White House and celebrate--that is just the ultimate despicable, 
political act. I just can't imagine that in the 21st century people 
would actually do that.
  The FDA has incredible influence over Americans' lives, and the 
Commissioner of the Federal Food and Drug Administration will lead the 
agency dedicated to ensuring that our medicine and food supplies are 
safe.
  It is the job of the FDA Commissioner, and has been for decades, to 
be an independent check on big pharmaceutical companies, to crack down 
on Big Tobacco, and to oversee the safety and efficacy of new 
prescription drugs, including, most essentially in the last few years, 
opioid painkillers. Unfortunately, Dr. Scott Gottlieb's record gives me 
serious concern, as Senator Markey has pointed out so well, that this 
Commissioner will fall short on all of these measures.
  We know the havoc that opioid painkillers have wreaked on communities 
across the country. My State of Ohio has had more overdose deaths from 
heroin, OxyContin, oxycodone, Percocet, opioids, morphine-based 
opioids; we have had more deaths than any other State in the United 
States of America. In my State and across this country, people die 
because of the opioid epidemic; 91 Americans, including 12 Ohioans, 
will die today--91 Americans, 12 Ohioans will die today--from opioid 
overdoses.
  The Commissioner will have a lot of tools to fight this epidemic that 
is ravaging our families and our communities. We need all hands on deck 
to fight this crisis. We need the FDA.
  Unfortunately, Dr. Gottlieb's record indicates he would not take the 
epidemic and the FDA's authority to rein in prescription painkillers 
and other drugs seriously, which is why I cannot support his 
nomination.
  I don't want to point fingers, but there are a whole host of reasons 
for this epidemic. One of them clearly is the proliferation of 
prescriptions and the manufacture of so many of these opioids. They are 
getting to market, and doctors are prescribing them, and pharmacists 
are filling them.
  I don't point fingers at individual people and even individual 
industries; we are all at fault and not doing this right. But Dr. 
Gottlieb has had a cozy relationship with big drug companies for 
decades as an investor, as an adviser, and as a member of the board for 
a number of these companies. He supported allowing those same companies 
to rush their drugs, including potentially addictive opioid 
painkillers, onto the market before we were sure they were safe--more 
on that in a moment.
  He has called into question the Drug Enforcement Administration's 
authority to police opioids, despite the fact that these drugs are 
often sold on the black market. He has defended industry's efforts to 
market new drugs and devices with minimal safety oversight. He has 
refused to answer questions about his previous work for pharmaceutical 
companies that make the opioid fentanyl. We know he participated in a 
meeting on their behalf at the time that the company was under FDA 
investigation for pushing off-label uses of fentanyl.
  Anyone who thinks we need more fentanyl on the market in many of 
Ohio's 88 counties should visit the coroner's office. Imagine this: In 
some counties, the coroner's office has had to bring in refrigerated 
semitrailers to keep up with the growing body count from the lives lost 
to overdoses. Think of that; just think of that picture bringing in 
refrigerated semitrailers to keep up with the growing body count from 
opioid deaths.
  Let Mr. Gottlieb explain himself to the parents, the children, and 
the friends who have lost loved ones to this deadly drug. A friend of 
my wife's, a woman she knew growing up, lost her son to fentanyl. He 
had a 2-year-old child. He was starting to come clean. My understanding 
is that he relapsed, and he passed away just a few days ago.
  We need a leader at the FDA who will step up the agency's efforts to 
fight this addiction epidemic, which is tearing families upside down. 
It rips up communities. We need a Commissioner who will fight the 
addiction epidemic, not one who will roll over for his Big Pharma 
friends. We need a strong public health advocate to address probably 
the worst public health crisis of my lifetime, a public health advocate 
who will continue to stand up to Big Tobacco with strong rules for all 
tobacco products, including newer products like e-cigarettes, which are 
particularly appealing to kids.
  The opioid crisis is certainly a bigger health crisis that we face 
right now, and tobacco is an ongoing public health crisis. We have made 
huge victories; we have made huge strides and have had huge victories 
in this country. Young people smoke in significantly lower numbers than 
they used to. Tobacco companies don't much like that, so they have 
introduced e-cigarettes. Tobacco companies are buying more and more of 
the manufacturing capabilities of these e-cigarettes. The FDA hasn't 
stepped up the way it should. I implore Dr. Gottlieb to do that, but 
there is no evidence so far that he cares enough to.
  Once again, his extensive business dealings call into doubt whether 
he can seriously serve as the people's cop on the beat when it comes to 
policing Big Tobacco. Dr. Gottlieb himself invested in an e-cigarette 
company--the new FDA Commissioner. He probably will be confirmed today. 
I accept that because for every Trump nominee, no matter their ethics, 
no matter their background, no matter their inability to serve well, no 
matter their lack of qualifications for a whole host of their 
responsibilities, almost every Republican--it is sort of like when one 
bird flies off a telephone wire, they all do, and they have voted for 
almost every one of these nominees.
  But think of this: Dr. Gottlieb's job is public health, his job is to 
police Big Tobacco. His job is to stand between these multimillion-
dollar marketing executives and the 15-year-old who is attracted to 
these e-cigarettes with the flavors and the colors and the marketing, 
and he has invested in the past in e-cigarette companies. What does 
that tell you? Can we really trust him to impose tough rules on these 
potentially dangerous products? Can we trust him to protect our 
children?
  Whoever is in charge of the FDA--whoever is in charge--must put the 
people's safety over drug company profits, whether it is addictive 
painkillers or e-cigarettes.
  I don't think Dr. Gottlieb is the right person for this. I hope I am 
wrong. I plan to vote no. I hope he proves me wrong. If he does, I will 
come back to the floor and applaud him. But from his background, from 
his statements, from his qualifications, from his investments, from his 
business background, I don't think he fits the bill.
  Mr. President, I suggest the absence of a quorum.
  Mr. President, I withdraw the suggestion.
  The PRESIDING OFFICER. So noted.

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