[Congressional Record Volume 163, Number 102 (Thursday, June 15, 2017)]
[Senate]
[Pages S3538-S3539]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                         Healthcare Legislation

  So we couldn't do that, which is a pretty easy thing to do, but now 
the Republicans are looking to bring out in the next 2 weeks a 
rewriting of our entire healthcare law, one-sixth of our economy, and 
they are talking about bringing this out for perhaps passage in the 
U.S. Senate during the next 2 weeks.
  I don't know of anyone who has seen a copy of this bill. I certainly 
have not seen it, and I am a member of the Senate Finance Committee. 
Senator Carper is a member of the Senate Finance Committee. We have not 
seen a copy of the bill, even though we are the committee of 
jurisdiction, along with the HELP Committee. I certainly want to be 
able to look at this bill, make sure that there are public hearings and 
an opportunity for input from all Members of the U.S. Senate--first 
those who serve on the relevant committees through the committee 
markups and then on the floor of the U.S. Senate. But what I understand 
from the majority leader is that may not be the case. That would be an 
affront to our Democratic institution. That would be insulting the 
Members of the Senate and the committee that I serve on, the Senate 
Finance Committee.
  I need to mention that because we do know what the House of 
Representatives sent over to us. We don't know if that is going to be 
the bill that is going to be brought out, but there hasn't been any 
hearing on the bill that the House of Representatives sent over to us.
  Compare that to the passage of the Affordable Care Act. We had 
numerous, dozens of hearings on the Affordable Care Act. We had months 
of negotiations on the Affordable Care Act back and forth--bipartisan 
negotiations. We had committee markups in two of our committees, and 
hundreds of amendments were considered. Many Republican-sponsored 
amendments were adopted on the Affordable Care Act. We went through a 
regular legislative process.
  Yet the Republican leadership is telling us that we are going to 
totally change the Affordable Care Act, totally change the healthcare 
system, and not offer the American people an opportunity to see what we 
are doing--or their elected Representatives to be able to offer 
comments or amendments to that? That is outrageous. That is not a 
democratic institution. We need to speak out about it.
  Now we are all vulnerable to that, all Americans. I have thought 
about the people in my State, the 400,000 who have coverage under the 
Affordable Care Act, who didn't have coverage prior to the Affordable 
Care Act. They are very much at risk because, according to the 
Congressional Budget Office, if we have on the floor of the Senate 
anything similar to what the House passed, most of those 400,000 are 
going to lose their insurance coverage. What are they going to do?
  Then we are talking about putting a cap on Medicaid. Well, have you 
talked to the Governor of your State? Have you talked to your State 
legislature as to how they are doing with their budgets? Do you really 
believe the States can pick up what we cut? The answer is obviously no.
  We offered an expansion of Medicaid so more working families, more 
veterans, more people who are vulnerable could get coverage. That is 
gone under the caps that the Republicans are talking about, putting our 
most vulnerable at risk.
  I started talking about minority health. Let me just underscore that 
with Medicaid. In my State and in every State, when you look at the 
percentage of people who are covered under Medicaid, it is much higher 
for the minority community because they historically have been 
discriminated against. They do not have the coverage going into the 
Affordable Care Act. That is going to affect our most vulnerable. It is 
also interesting to note that a higher percentage of veterans is under 
the Medicaid system. That will affect our veterans. Of course, our 
seniors depend upon Medicaid for longer long-term care. They are going 
to be adversely affected by these caps under the Medicaid Program.
  Then we have the impact on all of us who have insurance and may be 
able to

[[Page S3539]]

keep our insurance after this type of legislation. We are going to be 
adversely affected. Why? Because who do you think pays for those who do 
not have health insurance? You get cost shifting, and it is done in a 
more costly, expensive way so our healthcare costs go up. Those of us 
who have insurance pay more, and those who do not have insurance do not 
get the early interventions they need in order to stay healthy.
  The vulnerabilities continue because one of the things that was 
affected by the House-passed bill was what we call the essential health 
benefits. What we did is require that those benefits be provided under 
all healthcare plans, including Medicaid.
  So, yes, I could talk about obstetrics for women, which would be 
covered under all plans, and that women who need obstetrics would not 
have to pay a much higher premium as they would be in a high-risk pool. 
Because of the way the insurance would be done, only women who would 
need that would get into the plan, and it would cost a lot more. Yes, 
that discriminates against women.
  Again, I could also talk about minority communities that now have 
coverage for mental health and addiction because that is required under 
the Affordable Care Act. When it becomes discretionary with the States 
and they get into tight budget problems, they will lose that coverage.
  We are all talking about the explosion of opioid addiction in our 
communities. In Maryland, I think the rate now is 60 percent higher 
this year than last year of overdose deaths. Do we really want to cut 
one of the major tools we have in trying to get this epidemic under 
control? That is what we are talking about in regard to what the House-
passed bill does.
  At a minimum, we need to have public hearings to know what we are 
doing. This is a democratic institution. Under the Affordable Care Act, 
we had dozens of hearings. The committees of jurisdiction need to work 
on this bill. They need to be able to mark it up. They need to be able 
to offer amendments, which was afforded to every Senator in this body 
under the Affordable Care Act. Many of our colleagues who voted against 
the Affordable Care Act have amendments that were included in the 
Affordable Care Act. That is how a democracy works.
  Everyone is affected by this process but particularly the vulnerable, 
particularly those who are uninsured and those who will become 
uninsured. Those who have insurance and who have very few other options 
are going to find their benefits reduced. Minorities, our disabled 
population, older Americans, and women all will be discriminated 
against.
  At a time at which we want to focus on the progress that we have made 
to narrow the gap in minority health and health disparities, it would 
just be a tragedy to move in the wrong way, to reverse the progress we 
have made, and to do that without an appropriate process of 
transparency, which has been the hallmark of American democracy.
  I urge my colleagues in that there is still time. If you have 
proposals, work with us--all 100 Senators. I, certainly, have worked 
with my Republican colleagues on many healthcare issues that are now 
the law of this land.
  We offer to work with you. All we say is don't tell us that you are 
going to do this by repealing a bill and then come to us to try to fix 
it. Work with us to improve our healthcare system, and we will work 
with you. There is still time. Let's work together. Let's have public 
hearings. Let's get public input. Let's use the old-fashioned process 
of allowing us to offer amendments. Let's debate those amendments. The 
end result will not only be better legislation for the American people 
but legislation that we know will stand the test of time and give 
predictability to the healthcare stakeholders in our country.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Delaware.
  Mr. CARPER. Mr. President, I thank my friend, my neighbor from 
Maryland, for inviting a number of us to come to the floor today, this 
afternoon, to talk a bit about the Affordable Care Act. I am really 
honored to stand next to him here as we do sit next to each other on 
the Finance Committee and on the Environment and Public Works 
Committee. He is a great leader on both of those committees.