[Congressional Record Volume 163, Number 90 (Wednesday, May 24, 2017)]
[Senate]
[Pages S3153-S3157]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
TRUMPCARE
Mr. MERKLEY. Mr. President, our Nation and our government were
founded on a principle that can be summed up in three words: ``We the
People,'' the first three words of our Constitution, the three words
that our Founders wrote in supersized font so that no matter who you
were you would remember that this is the guiding mission of our form of
government. This is the guiding mission of the Constitution.
From across the room, you can't read the fine print of article I and
article II and so forth, but you can see what the Constitution is all
about: we the people.
Lincoln captured that notion when he spoke in his Gettysburg Address
and said: ``We are a nation of the people, by the people, and for the
people.'' He didn't describe our system of government as of, by, and
for the privileged. Our Founders didn't write ``We, the powerful and
privileged'' at the start of our Constitution. That is what makes us
different from the governments that dominated Europe, where the rich
and powerful governed on behalf of the rich and powerful. America
turned that on its head with our system of government. Our system of
democratic republic governance.
Therefore, we are at a very strange moment right now because just 20
days ago, 217 Members, a small majority over in the House, voted for a
bill that was all about government of and by the powerful, for the
powerful, of and by the privileged, for the privileged, not by the
people, for the people. They voted for TrumpCare.
We witnessed the House passing this horrific piece of legislation
that will ensure that millions of low-income and middle-class Americans
are worse off, will receive less care, and will have to pay more for
their healthcare, assuming they can even get it. But, on the other
hand, the bill delivers $600 billion in platinum-plated tax benefits to
the richest Americans.
Picture the situation: our President holding a celebration at the
White House, standing on a platform, crushing more than 20 million
people in terms of their access to healthcare, while celebrating a
golden plate with platinum-plated gifts to the wealthiest Americans.
That is what happened 20 days ago in the House of Representatives. That
is not a pretty sight and certainly doesn't fit the mission of our
Nation.
Franklin Roosevelt shared his vision of how we progress in the
following fashion. He said: ``The test of our progress is not whether
we add more to the abundance of those who have much; it is whether we
provide enough for those who have little.''
But the Trump principle that was supported by 217 House Members 20
days ago is the opposite. The Trump principle is that the test of our
progress is whether we add more to the abundance of those who have
most, while taking away from those who do not have enough. That is what
happened. That is the difference between Franklin Roosevelt and
government of, by, and for the people, and President Trump and 217
House Members who passed a bill of, by, and for the powerful and the
privileged.
It is astonishing to me that this happened. American citizens, when
they heard about the first version of this bill, TrumpCare 1.0, they
overflowed the inboxes, they proceeded to fill the streets, they
flooded the phone lines, and people up here heard them and said: We
understand. We don't have the votes to pass this TrumpCare 1.0 in the
House because we hear you telling us how horrific this bill is.
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So they went back to work. But in TrumpCare 2.0 they produced a bill
that is even worse than TrumpCare 1.0. They took an already bad bill,
they made it more painful and more damaging, and they jammed it through
without a hearing on the House side. They jammed it through without a
CBO estimate of how many people it would hurt or what it would cost.
They jammed it through because they didn't want to listen to the
American people who said: What you are doing is diabolical and wrong.
They didn't want to listen to the experts who said the same thing.
The experts weighed in from every direction--nonpartisans and
analysts, health policy experts, the associations that work in
healthcare, the groups that represent doctors, nurses, and patients.
The American Medical Association said: ``We are deeply concerned that
the AHCA,'' which I will simply call TrumpCare to keep away the
confusion--``We are deeply concerned that TrumpCare would result in
millions of Americans losing their current health insurance coverage,''
and that ``nothing in the MacArthur amendment remedies the shortcomings
of the underlying bill.''
The AARP called the bill ``a bad deal for older Americans ages 50-
64,'' because it ``would significantly increase premiums for all older
adults and spike costs dramatically for lower- and moderate-income
older adults.''
The AARP went on to state that the amendment that converted TrumpCare
1.0 into TrumpCare 2.0 was making ``a bad bill worse'' because it
``establishes state waivers that allow insurance companies to charge
older Americans and people with preexisting health conditions higher
premiums and weaken critical consumer protections.''
The American Cancer Society Cancer Action Network weighed in; the
American Diabetes Association weighed in; the American Academy of
Pediatrics weighed in; the American Heart Association; the American
Lung Association; the March of Dimes and many, many, many other groups
that are familiar, household-known organizations. These groups that
understand our healthcare system all came out and made it public that
this plan, this TrumpCare 2.0, is a bad plan. It endangers Americans'
health.
But 217 Members of the House didn't listen. The 217 Members voted for
the Trump principle of crushing ordinary Americans to deliver $600
billion in platinum-plated benefits to the richest Americans. If the
House had listened and put that bill 6 feet under with a stake through
its heart, I wouldn't be standing here today, but they sent that bill
over to the Senate. It is here for the Senate to consider. There are
100 Senators who now have to decide: Are they behind the principle of
``we the people,'' or have they decided that they want a different
constitution--one that is about ``we the privileged'' and ``we the
powerful''?
I know that when I took my oath of office, I liked the Constitution
the way it was written. I liked the principle behind this Constitution.
So it is of major concern that the Senate might proceed to adopt
TrumpCare 2.0 or modify it into TrumpCare 3.0.
Today, the Congressional Budget Office's score was released, which
told us of and evaluated TrumpCare 2.0. It found that more than 20
million Americans--in its estimate, 23 million to be exact--will be
uninsured under TrumpCare than under the Affordable Care Act. That
would bring the total of uninsured to a much higher total of 51 million
people under the age of 65 by the year 2026--nearly double the number
of uninsured. That hurts real people. It hurts every single one of
those individuals who lose their healthcare.
In my State of Oregon, just one piece, one provision of this bill,
which crushes the expansion of Medicaid--in Oregon, it is the Oregon
Health Plan--strips the healthcare of about 400,000 Oregonians. That is
a lot of human carnage. It is enough people that, if they were standing
hand to hand, they would stretch 400 miles from the Pacific Ocean to
the border with Idaho. That is how many Oregonians would be impacted by
this.
That is just the people who lose access to healthcare. There are many
others who would go to their clinics or go to their hospitals and find
that the clinics and hospitals have either limited their services or
shut down because, you see, our clinics have gained tremendously from
the investment under ObamaCare. In addition, they have gained
tremendously from the fact that the people who came in the door had
insurance to pay their bills. It is the reduction in uninsured
individuals who come through the door--the ones who cannot pay for
their care--that has dropped so much. With more people paying for their
care, the finances of the clinics and the hospitals are stronger. So
TrumpCare not only hurts the 23 million who will lose insurance, but it
hurts everybody, every American, by degrading our clinics and degrading
our hospitals.
Individuals share their stories and their concerns, people like
Lauren Rizzo in Portland. She is a single mother and small business
owner who is alive today thanks to the health insurance she received
through ObamaCare.
About 2 years ago, Lauren was not feeling well, so she went to get
checked out at a clinic. Lauren figured she would be given a
prescription for antibiotics and sent on her way. Instead, she was told
to head straight to the emergency room, where she received emergency
surgery to remove a 7\1/2\-inch mass from her abdomen. If Lauren had
not gotten insurance through the Affordable Care Act, ObamaCare, she
would not have gotten checked out, and she certainly could not have
afforded the $40,000 surgery bill and the nearly $60,000 in followup
care without going bankrupt. Very likely, without insurance, she would
have had this mass continue to grow in her abdomen and maybe threaten
her life. This may have been a life-and-death issue for her.
Here is what Lauren has to say in her own words:
I am a healthy and contributing member of society who is
able to contribute and pay my way and continue to grow and
succeed rather than someone who is slipping through the
cracks and needing assistance to get by. It seems to me that
turning people who are getting by into people who are falling
behind is good for no one. Even if there is no compassion in
our leadership's healthcare plan, I would have hoped someone
would have injected a note of common sense.
Her point, made very poetically and poignantly, is that if you cannot
get healthcare, you cannot remain a productive member of society. It is
not just about your quality of life, and it is not just about the fact
that you might suffer and that you might die, it is also about whether
you can be healed and contribute. That is an important piece of why
healthcare is so important.
Paul Bright of Sweet Home wrote to my office to share his story about
finally having healthcare thanks to the Medicaid expansion. Paul wrote:
I'm one of those hardworking Americans the Republicans
praise mightily--an entrepreneur, self-employed, buying
American--and I'm on Medicaid thanks to the ACA.
Without the ACA--that is ObamaCare--I'd have no insurance
at all to cover my prescriptions that keep me healthy so I
can continue to work.
Do I want to be making so little income that I qualify for
Medicaid? No. I want to be making a good income.
The only way I can continue working 60 hours a week to
increase my household income is if I can keep my
prescriptions and doctor appointments.
Without the medicine I need, I will become permanently
dependent on government services, not just health insurance,
but I will start requiring food stamps, housing assistance,
utilities assistance.
He concludes:
The smart economic decision is to keep me healthy so I can
grow our economy.
Paul is right. Keeping him healthy isn't just the moral thing to do,
it is a smart economic decision. Yet, under TrumpCare 2.0, Paul
probably would not stay healthy because he would not be able to afford
the appointments and he would not be able to afford the prescriptions.
He would fall through the cracks.
Then there is a grandmother in Lake Oswego, OR, who wrote to me about
her 12-year-old grandson who is living with a neurological disorder and
who has been hospitalized three times over the past 5 years. The first
time this woman's grandson was hospitalized at the age of 8, his
father's insurance covered a 3-week hospital stay. At the time, that
was enough to get the care he needed. But then we fast-forward to last
year. Her grandson, now 12, needed to be hospitalized for several
weeks, followed by residential treatment, followed by a brief period in
a transitional school--a 10-month period in
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total. Those 10 months were covered because of ObamaCare, because of
the ACA. For the past several months, this young boy has been home and
recovering successfully. The ACA made that possible.
Carol Nelson of Turner, OR, writes to me and shares her words. She
does not know how she will manage if her husband is kicked out of his
nursing home because of TrumpCare 2.0. She writes:
My husband lives in a nursing home. He does not remember me
after 33 years of marriage. I worry now. Will the new
healthcare laws and Medicare, which I will get in 2018, cover
us? Will he have to come home for me to take care of him even
though I cannot stand for more than a few minutes due to
congestive heart failure?
Carol continued:
I think there should be incentives to do what's best for
your health written into the law but not to take it away.
Without the ACA, I surely will die.
So here is a woman who has been married to her husband for 33 years,
but he has dementia so badly that he does not recognize his wife. She
would love to care for him at home, but she cannot. She has congestive
heart failure, and his condition is extremely severe.
Medicaid funds more than half of the nursing home admissions in the
United States of America. It is not simply about assisting struggling
families or hard-working or low-income families; it is also about
taking care of our seniors. She has a double challenge--her own care
and her husband's care. ``Without the ACA,'' she said, ``I surely will
die.''
Should that be the healthcare system we have in the United States and
because of which people are at the point of losing their access to
healthcare and putting their own lives at stake?
I think back to that issue of peace of mind. In a good healthcare
system, all have the peace of mind that their loved ones will get the
care when they are sick and that their loved ones will not go bankrupt
when they get sick. We have made big strides in that direction. In
Oregon, the 400,000 folks who are covered by the expansion of Medicaid
alone represent a big stride in that direction, the tens of thousands
who have gained access to care on the exchange because they can now get
community pricing and not be fended off by a preexisting condition or
blocked by a preexisting condition. They have more peace of mind.
We can do better. We could have a much simpler system, and we could
have a much more efficient system, but let's not go backward and throw
millions and millions of Americans off of healthcare.
Last night, I had the pleasure of speaking with Carol on the phone
and talking to her a little more about her life. She told me about the
cataract surgery she needed in order to be able to continue to see. She
said that without that, she would have lost her license, and if she had
not had a license, she could not have gone to the grocery store to feed
herself and her son, because they live out in the country--an hour's
drive from everything. She told me about the various preexisting
conditions she has had to manage--conditions that would certainly
prevent her from getting healthcare without her having the ACA,
conditions that, without medical appointments and prescriptions, would
cause her health to deteriorate rapidly without the ACA. That is what
she means when she says: ``I surely will die.''
It is a powerful story, but it is certainly not unique. Every day, I
am receiving stories like Carol's--story after story of folks who just
want the peace of mind of having access to healthcare--as well as
stories from constituents who are angry at President Trump and who are,
quite frankly, angry at the 217 Republicans who voted for a government
by and for the powerful and privileged over in the House 20 days ago.
They are also upset about the breaking of promises to the American
people. They heard the promises over the past campaign year. The
President made promise after promise on healthcare, and his healthcare
bill breaks promise after promise.
President Trump promised his plan would provide healthcare for all,
but it does not. According to the analysis we received just today, 14
million Americans would lose healthcare almost immediately. Within
another 10 years, that would grow to about 23 million Americans. That
is not healthcare for all; that is healthcare for 23 million fewer.
Promise broken.
Over and over again, President Trump said his plan would make
healthcare cheaper. The CBO estimates that premiums under TrumpCare 2.0
will go up 20 percent next year. Check this out. Here is the basic
math. A 64-year-old man who earns $26,500 a year would have his monthly
cost for healthcare go up from about $140 a month to about $1,200 a
month. When you are earning $26,500, by the time you pay for your rent
and your utilities and your car payment and your groceries, you do not
have much left, but you can still get health insurance if it is costing
you $140 a month. But if out of that little more than $2,000 a month
you earn, you would have to pay $1,200 a month, there is no way you can
afford that insurance. So President Trump promised that healthcare
would be more affordable--promise broken.
The President promised that under his plan, Americans would have
better healthcare. Currently you are guaranteed essential benefits,
including emergency services, rehabilitation services, maternity and
newborn care, mental health and addiction treatment, hospital
treatment, pediatric services--essential benefits. Those are the things
you expect, in a healthcare system, to be covered.
But TrumpCare throws out the requirement to have essential care
benefits. It means a State could choose to let insurers sell barebones
plans that cover virtually nothing.
So you are making your payment and you think you have insurance, and
then you get injured or you get sick and you find out it doesn't cover
anything. That is not healthcare. That is predatory insurance policies,
and that is what is allowed under TrumpCare.
So, Mr. President, you promised better healthcare and you delivered
predatory policies--promise broken.
The President said he would make sure we kept the protections for
preexisting conditions. He promised it. He repromised it. He triple
promised it. He continued to promise it. But the amendment that he
accepted for TrumpCare 2.0--passed 20 days ago by 217 Members of the
House, in favor of government of, by, and for the powerful and the
privileged--broke that promise and said States could allow the
elimination of community pricing.
What that means is that you have preexisting conditions, but you can
get the policy at the same price as everyone else. If you destroy
community pricing, it means that when you file for your policy, the
insurance company says: Well, let's see just what your problems are.
Oh, we see you have asthma. We are going to charge you more. Oh, we see
you have diabetes, we are going to charge you a lot more. We see you
have delivered a child, which can create health problems. We are going
to charge you more because you are a mother. We see that you had an
episode of cancer. It is in remission--good news--but the odds of your
getting it are higher than someone else; so we are going to charge you
more.
That is because their goal is to make sure those people who have
preexisting conditions are not in their insurance pool, because they
will make more money. That is an assault on the premise that everyone
will be able to have affordable healthcare because those folks are
told: Because you have this condition or that condition, we are going
to charge you more. The charges will be so high--and will be intended
to be so high--that they will not be able to buy insurance. So they
won't be covered.
That is part of the reason that the CBO has analyzed the fact that
there will be 23 million more people without insurance come 2026 under
TrumpCare than under current law. We can think of this as a tax. For
those who actually can summon the funds, it is a set tax on sick
people, and the sicker you are, the higher the tax bill you pay under
TrumpCare.
So when the President promised not once or twice or thrice but
multiple times to make sure that we keep the protection for people with
preexisting conditions, that was a promise broken.
The President promised not to cut Medicaid. As I was waiting to speak
last night, I was watching a local television channel, and they were
playing tapes of one rally after another where
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President Trump went out there and said: I am different; we will not
touch Medicaid or Medicare or Social Security. He was emphatic. He was
passionate. He was convincing.
He broke that promise under TrumpCare. It cuts $880 billion out of
Medicaid. On top of that, the budget he released yesterday calls for
$600 billion more on top of the $880 billion. If you cut $1.5 trillion
from Medicaid, that is the promise broken. It is not broken by a
little. When the President said he wouldn't touch Medicaid, he didn't
proceed to break that promise in a tiny little way. No, he smashed it
with a sledge hammer. He demolished it. He turned it into dust because
he cuts $1.5 trillion out of Medicaid.
Medicaid doesn't just help provide healthcare to hard-working,
struggling families. It pays for nearly half of all births in America.
It provides coverage for one out of three children--healthcare for one
out of three children in America. It pays for nursing home care for
more than half of the American seniors who need nursing home care.
Medicaid is the single largest payer for mental health and substance
abuse disorders.
A lot of folks here have come down to this floor--from both parties--
to talk about taking on the opioid epidemic, a substance abuse
epidemic, a highly addictive drug doing great damage across America.
Medicaid is the largest payer for substance abuse disorders in America,
and TrumpCare cuts it by $1.5 trillion.
Two out of three school districts rely on Medicaid funds to provide
services to children with disabilities.
So there we have it--one broken promise after another.
Now we turn to the Senate because it is time for this Chamber to
respond. The only appropriate response is for us all to get together,
dig a deep hole here on the floor of the Chamber, throw that House
bill--TrumpCare 2.0--into it, light it on fire, drive a stake through
it, and make sure it never sees the light of day. That is the only
reaction that honors our ``we the people'' government. That is the only
action that would honor the promises that President Trump made to the
Nation while campaigning.
Now, a group of my colleagues are holding secret meetings far from
the public to work out a new version of TrumpCare--TrumpCare 3.0. There
is no bipartisan dialogue on this, and I am certainly not invited to
listen in. So I can't tell you what they are coming up with, but I can
tell you this: It is a process completely different than when we had a
bipartisan, over a year-long process to debate and examine the question
of the Affordable Care Act--ObamaCare. The Finance Committee held 53
hearings. They spent 8 days marking up the bill. That was the
committee's longest markup in over two decades. They considered 135
amendments. That was one of the two major committees that worked on
ObamaCare. The other was the Health, Education, Labor, and Pensions
Committee, known as the HELP Committee. They held 47 hearings--not
secret meetings in some room but public and bipartisan meetings with
all committee members welcome and the press welcome, hearings,
roundtables, and walkthroughs. Then, they had a month-long markup--a
month long. I was there. I was on the committee. We had a square
table--two sides with my Republican colleagues and two sides with my
Democratic colleagues. During that markup, amendment after amendment
was considered. Three hundred amendments were considered--bipartisan
amendments, amendments from Democrats, amendments from Republicans--and
160 amendments were adopted from my Republican colleagues--160
amendments from across the aisle. That is the type of bipartisan work
that was done.
Let's compare that to TrumpCare: no hearings in the House, no public
display of the bill for a lengthy period for it to be publicly
analyzed. There was virtually no chance for the public to see the
actual text and weigh in. It passed under a process of rapid transit
through the floor of the House, and then it came over here to the
Senate.
Is the Finance Committee now holding hearings similar to what we did
years ago on ObamaCare? We had 53 hearings. How many hearings has the
Finance Committee had on TrumpCare 3.0? None, not one. The HELP
Committee--the Health, Education, Labor, and Pensions Committee--held
47 hearings, roundtables, and walkthroughs. How many hearings has the
HELP Committee had here in the Senate on TrumpCare 3.0? Not a single
one.
Secrecy is the guiding principle of the day--secrecy that might
produce another version of TrumpCare that will be devastating to
millions and millions and millions of Americans. So, of course, they
don't want the public to watch that process. Of course, they don't want
to have weeks of hearings and markups that enable people to have
hundreds of bipartisan amendments. If you are trying to push through
something to destroy healthcare in America, you want to do it as
secretly as possible. That is what is happening in the Senate at this
very moment.
That is not the kind of process you should have in a democratic
republic. That is the kind of process you have when you are about to do
something diabolical and destructive that will hurt we the people.
ObamaCare, or the Affordable Care Act, isn't perfect. We could work
together to make it much better. We could say no to all of the
strategies that the Trump administration is doing right now to
undermine the success of the marketplace.
Remember, the marketplace was the Republican idea. That was the
Republican plan: Have a marketplace where private healthcare insurance
companies could compete. That is what came from across the aisle. But
now the Trump administration is doing everything it can to undermine
that particular strategy. They are hesitating about whether to provide
the cost-savings funds that allow the companies to provide lower
premiums and lower deductibles. That hesitation means the insurance
companies can't price out their policies for next year. So they either
have to exit the exchange or they have to raise the price of their
policies a lot higher.
The Trump administration is deliberately sabotaging the marketplace.
Then there is the fact that the whole point of the markets was to
make it simple for an insurance company to go from one State to another
State, to reach all of the customers at the same time of year--all
making decisions--and you can reach out and talk to them. You can sell
your policy easily. But the point is, a new company coming into the
marketplace is concerned they will get a disproportionate share of
those who are very ill, so there is an adjustment that takes place to
say: No. You can come into this marketplace, and we will guarantee that
you will get an adjustment if your patients end up being sicker than
the average patients.
That is intended to make multiple insurers come in and compete with
each other. But my Republican colleagues destroyed that provision. It
is called risk corridors. They destroyed that provision. They are
destroying the ability of companies to competently, responsibly come
into the insurance marketplace and participate in the exchanges.
So not only do we have the diabolical TrumpCare 2.0 and the secret 13
proceeding to develop TrumpCare 3.0, we also have the administration
destroying the ObamaCare exchanges, the marketplaces, which were the
Republican idea brought into that bill.
I will do all I can to make sure we don't throw out healthcare for 23
million Americans. I hope every single Senator here, having come to
this body and I know holding dearly this Constitution, will fight for
``we the people'' and not ``we the powerful and privileged'' and will
fight against a bill that not only hurts healthcare for those 23
million people but also destroys healthcare institutions for everybody
else because it undermines the financing of both the clinics and the
hospitals.
In our own States, we are all hearing our Lauras and our Pauls and
our Carols and our grandmothers talking about their 12-year-old
grandsons. We are hearing them all say: Just say no. Do your job. Make
our healthcare system work better. Live up to your commitment to ``we
the people,'' a democratic republic, to fight for a nation of, by, and
for the people.
Mr. President, I suggest the absence of a quorum.
The PRESIDING OFFICER. Will the Senator withhold his request?
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Mr. MERKLEY. I withhold my request.
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