[Congressional Record Volume 163, Number 102 (Thursday, June 15, 2017)]
[Senate]
[Pages S3545-S3547]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                         Healthcare Legislation

  Mr. WYDEN. Mr. President, I want to start my remarks on healthcare 
and what is ahead over the next couple of weeks in this way.
  For almost 7 years before I got elected to the Congress, I was the 
director of the Oregon Gray Panthers, which is a senior citizens group, 
and I ran a legal aid office for the elderly. I made the judgment then 
that healthcare was and always would be the most important issue. I 
made that judgment because I have always felt that if you and your 
loved ones do not have their health, then pretty much everything else 
does not matter.
  The Presiding Officer of the Senate, of course, is a skilled 
healthcare provider and knows a lot about these issues, and I am really 
going to use that as my reference point today in making the judgment 
that having quality, affordable healthcare for your families and 
yourselves is paramount to everything else.

[[Page S3546]]

  My view is that the proposal being considered here in the Senate of 
cutting hundreds of billions of dollars in funds from the social safety 
net--the Medicaid Program, which is the lifeline for seniors and kids 
with special needs and for the disabled--is going to put at risk the 
health and well-being of millions of Americans if it is passed.
  It is why I want to take some time to explain what it actually does 
so that people all across this country will be in a position to make 
their voices heard--to speak up, to do their part--so that when this 
debate comes to the floor of the U.S. Senate, as I believe it will in 
the next couple of weeks--and it moves very quickly--every Member of 
this body will have heard, loud and clear, what Americans think of this 
proposal, and I do not think that that assessment is going to be too 
kind.
  Now, the House passed their version of TrumpCare by a razor's edge, 
and to put it in a pleasant way, over here, Senators looked at it and 
said: No way. No thanks. My colleagues in the Senate majority said: We 
are throwing this bill out, starting fresh, and we are going to do it 
right. So I am going to start with where that process got lost.
  The majority convened a special working group made up of 13 
Republican Senators, all of them men, and it turns out, based on 
comments that have been reported, the Senate bill isn't going to be all 
that different from what the House was talking about. So Republicans in 
the Senate are pretty much picking up where the House left off on 
TrumpCare, and the legislation that is being crafted stays hidden--
stays behind closed doors and in a position where, for example, if you 
are a Democrat on the Finance Committee, you don't even know what is in 
it. It is not going before committees. It will not be put forward for 
amendment in a markup. With barely any public notice, the bill will hit 
this floor for 28 hours of debate--that is that.
  I will just briefly describe a session we had in the Finance 
Committee this week where there was discussion from the other side of 
the aisle that maybe there was a big partisan divide with respect to 
healthcare. I listened a bit. Finally, I said: I don't know how you can 
have a partisan divide about a bill that you can't read.
  I am the senior Democrat on the Finance Committee. The Finance 
Committee is the committee that has jurisdiction over hundreds of 
billions of dollars in payments for Medicare and Medicaid and the 
various tax credits that are part of the Affordable Care Act. This is 
the committee with the authority to address the management of hundreds 
of billions of dollars for those programs--Medicare, Medicaid, tax 
credits--and we see nothing. Not only have there been no hearings, we 
haven't seen anything. Something has been sent to the Congressional 
Budget Office. Who knows the answer to that. We haven't seen that 
either.
  So that is the process that would dictate a radical transformation of 
one-sixth of the American economy--the American healthcare system--
affecting millions and millions of Americans.
  That is what we are looking at right now for the next couple of 
weeks, and it is pretty different than what happened during the 
Affordable Care Act.
  I want to focus on a few points just with respect to that. The first 
is especially important, as I have said, to the Finance Committee that 
deals with Medicare and Medicaid and these crucial aspects of 
healthcare in America. The Senate Finance Committee has been cut out of 
this process. The chairman, Senator Hatch, I, and 24 other committee 
members--there has been nothing for us to examine as a group to do what 
the Finance Committee tries to do best, which is to work in a 
bipartisan way. That is what we have done so often in the past, which 
is to sit down and try to take the good ideas that come from both 
sides, from the staff who knows healthcare inside and out, with years 
of experience working on healthcare matters.
  I have a little bit of a special interest in this because I wrote 
something called the Healthy Americans Act before the Presiding Officer 
was here in this body. Eight Democratic Senators and eight Republican 
Senators joined together in comprehensive healthcare reform for the 
first time--for the first time ever before.
  We have done a lot of good work on issues that represent the big 
challenges ahead. We know, for example, Medicare today isn't the 
Medicare of 1965, when it was about broken ankles, Part A or Part B, a 
bad case of the flu. Today Medicare is about chronic illness--diabetes 
and heart disease and strokes and cancer. We have worked on that in a 
bipartisan way. Bipartisanship is what the Finance Committee is all 
about.
  So in the runup to the Affordable Care Act, we held more than 50 
hearings, roundtables, walk-through sessions. It wasn't exactly 
exciting. We always used to say: If you are having trouble sleeping, 
come by for a while and you will be knocked out in a matter of minutes. 
But that is where you do the hard work of legislating.
  When the Finance Committee finished the drafting process, the 
legislation sat online for 6 days before we went through the formal 
committee consideration--what we know up here as a markup. A total of 
564 amendments were posted online before the markup began for all to 
read. The markup lasted 8 days. There were 130 amendments in the 
longest markup in 22 years. Two dozen Republican amendments were 
adopted, and the bill passed with a bipartisan vote.
  We all got pretty sick of the hearing room by the time it was over. I 
will just read a quote from Senator Grassley with respect to the 
Finance Committee markup of the Affordable Care Act. Senator Grassley 
is the chairman, of course, of the Senate Judiciary Committee and the 
former committee chairman of the Finance Committee, and a very careful, 
thoughtful legislator. He said: ``This was the most open and inclusive 
process the committee has undertaken in its history. . . . ''

  He went on to say: `` . . . I believe, since I have been on the 
committee.''
  So that is not a Democrat. That is Senator Grassley, the chairman of 
the Senate Judiciary Committee. I am sure Senator Murray has similar 
accounts of the process under the late Senator Kennedy. That 
legislation was online for days as well.
  That is what the legislative process is supposed to look like. It is 
a process that starts from the bottom up, and it is out in the open. 
Sunlight has always been the best disinfectant. You get hearings. You 
get study. You get debate. You marry the best ideas of both sides.
  I have always felt that bipartisanship is not about taking each 
other's lousy ideas; bipartisanship is about taking each other's good 
ideas, but because of the process the Republican leader is insisting 
on, that is not what the majority has on offer. What is in the works is 
hidden away so the public and Americans across this country who might 
be sitting in a coffee shop and would like to pull up a proposal on 
their laptop, they can't do it, and there aren't any hearings on what 
might be going in the bill as well. That, in my view, is the wrong way 
to build a sweeping, massive proposal like this, which, for so many of 
those who are walking on an economic tightrope, balancing their food 
against their fuel and their fuel against their medical care, this 
isn't some abstract issue for them. It is a matter of life and death.
  This proposal is built around an attack on Medicaid. The last version 
of the bill that anybody has been allowed to see cut the program by 
more than $800 billion, but there haven't been any hearings on what 
that would mean for the 74 million Americans who get their healthcare 
coverage through Medicaid. Nobody has been brought before the Finance 
Committee to talk about how you would not endanger the Medicaid nursing 
home benefit with this proposal, and that benefit pays for two out of 
three nursing home beds in America. There hasn't been a hearing 
examining the effect of the staggering implications of Medicaid cuts on 
37 million kids enrolled in the program, particularly what it means for 
kids with disabilities and kids in special education classes.
  At home in Oregon, when we had town meetings and roundtables on it, I 
just brought up--just raised the issue very gently--about the prospect 
of those special needs kids being hurt with this proposal, and the room 
just broke out in sobs.
  There haven't been any hearings on how much worse the opioid epidemic 
will get in States across the country when people enrolled in Medicaid 
lose access to treatment for mental health and substance abuse 
disorders. Just this morning, I talked about a

[[Page S3547]]

brandnew idea that seems to be picking up some interest in the majority 
about basically coming up with kind of a separate way to fund the 
coverage for opioids. Instead of it being a guarantee of being able to 
get access to services, it would sort of be a separate program, which 
also is not in line with sensible healthcare policy. As the Presiding 
Officer knows, so often those addicted to opioids have multiple 
conditions. In other words, if you are a young person who is addicted 
to opioids, you might well need mental health services. If you are an 
older person who is addicted to opioids, you might need services 
relating to chronic illness.
  So I want everybody in those States across the country--particularly 
in the Midwest and in the industrial Northeast--although opioid 
addiction has hit this country like a wrecking ball from Portland, OR, 
to Portland, ME. There are a lot of people paying attention to what is 
going to happen with respect to coverage for those addicted to opioids, 
and based on this proposal I have been reading about that is being 
floated, this is a prescription for trouble for those trying to come 
back from opioid addiction.
  Then, I want to mention the bill's provisions on preexisting 
conditions. When the Affordable Care Act was written in committee, the 
bedrock guarantee of protection against discrimination for those who 
have preexisting conditions and protecting those who have preexisting 
conditions with airtight, loophole-free protection--that was at the 
heart of the Affordable Care Act. My view is TrumpCare takes a 
jackhammer to that bedrock protection, cracking open loopholes that 
benefit insurance companies. Americans are aghast that their elected 
representatives would support the idea. I know that because I have had 
46 townhall meetings in my State this year, and I hear about it at 
nearly every one.
  So one would think this would generate a lot of interest in the 
Senate Finance Committee--the committee with jurisdiction over 
Medicaid, for example--because there are a lot of those folks who have 
preexisting conditions. No discussion. Zero discussion--zero--of any 
proposal that the Senate could be considering over the next couple of 
weeks that rolls back protections on preexisting conditions.
  I gather the House bill just basically takes the waiver process, 
which in the Affordable Care Act was designed to let States do better; 
in the House, they let States do worse--considerably worse--and one of 
the most objectionable features is the States can get a waiver and 
unravel some of those strong protections for people with preexisting 
conditions.
  Now, if the healthcare changes I have mentioned aren't bad enough, 
TrumpCare also takes hundreds of billions of dollars of healthcare from 
needy and vulnerable people and, in effect, hands it in tax breaks to 
the most fortunate. Nobody has come before the Senate Finance Committee 
with authority over taxes to explain why the Congress ought to raid 
healthcare programs for the vulnerable to fund tax cuts for the 
fortunate few.

  Our committee--the chairman and I, along with all the Democrats and 
several of the Republicans--has been prevented from legislating out in 
the open on this proposal because the Senate TrumpCare plan has 
essentially been pushed out of view. It is clear that this isn't just 
sidestepping the Finance Committee. The public--the American people--
have been cut out of the process when healthcare policy that will 
affect millions for years to come is being written here.
  The majority leader has said he pretty much is not interested in 
input from Democrats. The Republican healthcare plan is going to move 
by reconciliation. That is a Washington word, folks--when you are at a 
coffee shop, nobody is talking about reconciliation, but it is 
basically our way or the highway. We are going to do it our way, and 
that is that. It is the most partisan road you can go down in the 
Senate. It relies on moving as quickly as possible with the least 
possible sunlight.
  As far as I can tell, the Senate bill is going to be hidden until 
virtually the last minute, at which point it will come straight to the 
floor for a very short, abbreviated debate.
  That is not what happened when the Affordable Care Act came up. The 
Senate spent 25 consecutive days in session on healthcare reform, the 
second longest consecutive session in history--week after week, 
spirited debate, mid-November into late December, vote after vote after 
vote. In total, the Senate debated the Affordable Care Act for nearly 
220 hours. That kind of extended give-and-take from both political 
parties you just can't have under this partisan ``our way or the 
highway'' approach known as reconciliation.
  When the Senate plan hits the floor, there will be 20 hours of debate 
before time expires and the final votes are cast. That is it. That is 
it. We won't have seen a bill until the last minute, and then one-sixth 
of our economy is going to be handled and framed for decades to come in 
a short and regrettably partisan debate.
  I have said from day one that the Affordable Care Act is not perfect. 
No major piece of legislation ever is. For major legislation to work 
and for it to last, it has to be bipartisan. That is why I mentioned 
that I put in a bipartisan bill--eight Democrats and eight Republicans. 
But you don't get it exactly your way. So I was very glad when the 
Affordable Care Act took that portion of our bill--the portion of the 
bill that had airtight, guaranteed protection for Americans from 
discrimination when they had preexisting conditions.
  The reason we felt it was so important--the 16 of us, eight Democrats 
and eight Republicans--is that if we open up the opportunity for 
discriminating against people with preexisting conditions again, we 
take America back to the days when healthcare was for the healthy and 
the wealthy. That is what happens if you allow that discrimination. If 
you are healthy, there is no problem. If you are wealthy, there is no 
problem, either. You can just write out the checks if you have 
preexisting conditions.
  The process the Senate is headed down now is as partisan as it gets. 
Unfortunately, what Senate Republicans are doing now makes what the 
House was up to almost transparent.
  I am going to close here with just one last comment. Now is the time 
for the American people to get loud about healthcare--really loud--
because the well-being and health of millions of Americans is at stake 
here in the Senate over the next 2 weeks. For older people who could 
need nursing home care, for seniors who aren't yet eligible for 
Medicare who are between 55 and 65 and who could face huge premium 
hikes, for the millions who work for employers who thought they were 
safe, the House bill removes the caps on the out-of-pocket expenses 
they have. If somebody gets cancer in America, they bust those caps in 
a hurry. Yet that is what the House is willing to do, and I don't see 
any evidence the Senate is willing to change.
  This debate didn't end when the theatrical production on the South 
Lawn of the White House took place a few weeks after the vote in the 
House of Representatives. My hope is--and I sure heard about it from 
Oregonians last week when we had townhall meetings across the State; 
there is concern, there is fear, and there is frustration about why 
they can't be told what is in this bill--that there is still time for 
Americans to make a difference because political change doesn't start 
from the top and go down. It is bottom up. It is not top down. It is 
bottom up. There is still time for the American people to be heard and 
to make sure their Senator understands how they feel about this, what 
is at stake, and, in particular, to get an explanation about why they 
can't be told now what is in this bill.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Blunt). The Senator from Texas, the 
majority whip.

                          ____________________