[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.

[[Page S3154]]

  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

[[Page S3155]]

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

[[Page S3156]]

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?

[[Page S3157]]

  

  Mr. MERKLEY. I withhold my request.

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