[Congressional Record Volume 163, Number 105 (Tuesday, June 20, 2017)]
[Senate]
[Pages S3621-S3624]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                         Healthcare Legislation

  Mr. MERKLEY. Mr. President, on May 4 of this year, there was a party 
at the White House, a celebration--a celebration that the House had 
passed TrumpCare. Indeed, the President wanted to invite people over 
and say what a great job they had done and what a great bill they had 
passed. He called it a ``great plan.'' He said the House plan was 
``very, very incredibly well-crafted.''
  That was on May 4--a party at the White House, a celebration--but 
what a difference a month can make. A week ago, on Tuesday, June 13, 
the President had another gathering, and at this gathering he said that 
the bill from the House was ``mean,'' and he went on to use a very 
derogatory phrase to describe it.
  So what happened between May 4 and June 13? Did the bill change in 
some way? Absolutely not. It had already been passed out of the House. 
Apparently what happened is that someone explained to the President 
what was in it, and he said: That is terrible. We can't do that. It is 
a mean bill. And he used other vivid language to say just how bad it 
was.
  What feature of the TrumpCare bill did the President get briefed on 
that made him say that it was mean? It certainly is a mean-spirited 
bill. It certainly is a hard-hearted bill. It certainly is destructive 
to the quality of life of millions and millions of Americans. So which 
aspect of the bill was he referring to?
  I asked that question of the Secretary of Health and Human Services, 
Tom Price, when he came to the Senate for a hearing last week. I asked 
the Secretary if he shared the President's opinion that the TrumpCare 
bill was a mean bill. He didn't have an answer for that. He wouldn't 
say whether, as a leader in the administration on healthcare, he shared 
the President's opinion.
  I asked whether he thought the President thought it was a mean-
spirited bill because it ripped healthcare from 23 million Americans. 
The Secretary of healthcare didn't answer.
  I asked whether it was mean because it eliminated essential health 
benefits like emergency care and rehabilitation services and mental 
health and addiction treatment and maternity coverage for women having 
a child. The Secretary again refused to answer.
  And he proceeded to say things like ``Well, I wasn't in the 
meeting,'' and that he hadn't talked to the President about why the 
President didn't like the bill. One would think that the Secretary of 
Health and Human Services, upon hearing that the President thought that 
the bill he had advocated for was terrible, would actually go to him 
and say: What is it you thought was so terrible? That might inform the 
conversations here in the Senate. But he said that he hadn't talked to 
the President about it. The Secretary of Health and Human Services 
didn't want to know why the President disliked this bill.
  I asked if the President thought that this was a mean bill because it 
has vast premium increases for older Americans. An individual in their 
mid-sixties, prior to the age for Medicare, a 64-year-old earning 
$26,500--how much would they pay under current law and how much would 
they pay under TrumpCare? Under current law, the answer is about $140 a 
month. And under TrumpCare from the House, the answer is $1,200 per 
month--an eightfold increase. How can anyone earning a little over 
$2,000 a month spend $1,200 on health insurance? It is an impossible 
situation.
  So, of course, those Americans in that situation would not be able to 
buy health insurance, would not be able to access healthcare. Is that 
why the President thought it was mean? Did the President get briefed on 
the damage it would do to our older Americans? Or was the President 
concerned about the impact on our older Americans who need to have care 
in a nursing home? Is the President finally aware that Medicaid pays 
for more than 6 out of 10 individuals who are in a nursing home because 
they need a level of care that can't be provided in the home?
  I went and visited a nursing home over the weekend in urban Oregon 
and then visited one in rural Oregon, in Klamath County. In Klamath 
County they told me that almost 100 percent of their citizens in long-
term care are paid for by Medicaid. Nationally, it is a little more 
than 6 out of 10, but in this rural community, almost 100 percent. I 
thought about the residents there and what happens to them. Under this 
bill, when Medicaid is slashed massively and 23 million folks lose 
access to it, what happens to them? One woman, Deborah, said: Senator, 
Medicaid pays for my bill and if it doesn't exist for me--if it is 
taken away--I am on the street, and that is a problem because I can't 
walk.
  So picture an older American, a senior American who needs an 
intensive level of care that can't be provided in the home being thrown 
into the street in a wheelchair, unable to walk, and, by the way, no 
support structure because in order to qualify for Medicaid to pay your 
bill, you have to have spent down all your own resources, so it isn't 
like somebody has a backup plan. Maybe there are family members who 
will take them in and provide an intensive level of care. Maybe a few 
will have friends who will take them in and provide an intensive level 
of care. But for the vast majority, that support structure isn't there, 
and that means they are going to be on the street. Is that why the 
President said it was mean?
  Was it because the bill said States can charge more, allow insurance 
companies to charge more for individuals with preexisting conditions? 
That is certainly a huge problem. Community pricing has given access to 
insurance at the same price to everyone in America, regardless of 
preexisting conditions, but, unfortunately, TrumpCare changes that.
  I think we need to recognize that now, here in the Senate, 13 
Senators are working to craft a Senate version of TrumpCare, and they 
are terrified--terrified of the public seeing their bill. It is a 
vampire bill. It is afraid of the sunlight--the sunlight of public 
commentary, input, even a public discussion from experts. They are 
afraid of their citizens. They are afraid of the expert commentary. And 
they want to hide it until the last second so they can bring it to the 
floor--next Thursday, a week from this Thursday--and try to pass it in 
a moment's time, less than a day.
  I was fascinated that our Secretary of Health and Human Services--
after there were more than 100 hearings and roundtables and walk-
throughs of the healthcare bill in 2009, after consideration of more 
than 300 amendments in the Senate, after more than 100 Republican 
amendments that were adopted,

[[Page S3622]]

minority amendments adopted, after more than 25 days of debate on the 
Senate floor--complained that the bill and the process were not 
transparent. If that wasn't transparent, how do you score the 
transparency of a bill where there have been zero committee meetings, 
zero chance for legislators to weigh in, zero chance for public input 
by experts, zero chance for the citizens of the United States to see 
this bill and share their feelings, zero chance for us to go back to 
our own States and have townhalls and ask for input? Well, you give it 
an F. It is a process completely out of sync with the responsibilities 
that every Senator took when they took the oath of office to be a 
Member of a legislative body--not a secret body, a legislative body, 
which implies deliberation in committee and deliberation on the floor 
and deliberation with constituents back home.
  There is a phrase for the Senate--probably not merited; in fact, I am 
sure it is no longer merited--that the Senate was the world's greatest 
deliberative body. But crafting legislation in secret that affects the 
quality of life of millions and millions of Americans, with no 
deliberation, that is not a legislative process. That is not what was 
envisioned under our Constitution, our ``we the people'' Constitution. 
It wasn't a ``we the secret group of powerful folks accommodating 
powerful special interests, government by and for the powerful.'' That 
wasn't the introduction to our Constitution. Perhaps Members might read 
the first three words of the Constitution. Perhaps folks might go back 
and look at our history of why we have this floor to debate the issues, 
because that is what a system of government of, by, and for the people 
is all about.

  In my home State, the elimination of Medicaid expansion--that is, the 
Oregon Health Plan expansion--would throw 400,000 people off of 
healthcare. Stretching that timeline from a couple years to 7 years 
doesn't change the fact that 400,000 people lose healthcare. That is 
mean-spirited. That is hard-hearted. That is terrible healthcare 
policy.
  It is not just those individuals who are affected. The uncompensated 
care rate has dropped enormously in Oregon, from 15 percent to 5 
percent. The result is that there is much more income to our clinics 
and to our hospitals, and the result is better healthcare for 
everyone--everyone in our rural communities, everyone in our urban 
communities. Nonetheless, the majority persists in wanting to destroy 
this improvement.
  I am hearing from people like Elizabeth from Portland, who wrote to 
say that the Oregon Health Plan saved her life. The Oregon Health Plan, 
or Medicaid, saved her life. She was in school, and she had some health 
problems that were getting worse because of stress. But she didn't have 
a job and didn't have insurance, and things were getting bad. Then the 
Affordable Care Act came around, and it extended coverage. Since then, 
she has gotten her health problems under control, finished school, and 
was able to get a job. In Elizabeth's own words:

       I am once again contributing to society. I just need a 
     little bit of time and help and I'm back on my feet.

  Isn't it the right thing to provide a foundation for every single 
American to have access to quality healthcare, so that when they get 
sick, it helps them get back on their feet?
  Ask yourself: What is your value? Is it your value that every 
American should have access to affordable healthcare? That is my value. 
That is what I am fighting for. What are you fighting for? Are you 
fighting to destroy healthcare for millions of Americans? Is that your 
value--to make life difficult and hard and mean-spirited and hard-
hearted and terrible and painful for millions of Americans? Is that 
your value? If so, then keep up with this secret plan to destroy 
healthcare for millions of Americans. But if you value your 
constituents' quality of life, if you value their peace of mind, then 
put a stop to this abomination, this anti-democratic process. Insist 
that there is at least a month of consideration of the bill so that 
citizens can weigh in, so experts can weigh in, so committees can 
deliberate, so committees can propose amendments and improvements. 
Insist on that.
  We just need three Members of the majority party to believe in the 
responsibility of this Chamber to hold a public debate and insist that 
they will not vote to proceed to the bill unless we have at least a 
month of opportunity. That is only one-ninth of what we had in 2009. It 
is only a fraction of the committee meetings, roundtables, and walk-
throughs we had in 2009. It would be only a fraction of the amendments 
offered in 2009. It would only be a fraction of the time here on the 
Senate floor we had in 2009. Don't you believe we should have at least 
a fraction of the public deliberation we had just 8 years ago before 
jamming this through and destroying healthcare for millions of 
Americans? What does peace of mind mean to you?
  I will tell you what it means to my constituents. It means that when 
their loved one gets sick, their loved one will get the care they need. 
It means that when their loved one gets sick, they won't go bankrupt. 
That is the peace of mind we are talking about, and that is the peace 
of mind that is so profoundly disturbed when you have a secret group 
meeting with powerful special interests, devising a bill they are 
afraid to show to the public of the United States of America. I would 
never want to have to vote on such a major bill without being able to 
hear what my citizens in Oregon think. I don't think any Member of this 
Senate should agree to vote on a bill with no deliberation and no 
public hearing.
  So we need three champions. Just three out of 52. It should be 52 out 
of 52 who insist on a quality public process. We have heard the 
comments in the hallways, many Members of the majority dislike the fact 
that there is a secret process that their majority leader is insisting 
on. We have heard that they don't like it. It is not right. But do you 
know what? Every Member here has a chance to say no to the secret 
operation, the secret committee of 13, and the last-second presentation 
of such a bill on the floor.
  The issue of the changes in healthcare without public deliberation 
terrifies folks like Deborah from Hillsboro, OR. She was diagnosed with 
Crohn's disease 8 years ago and has to take regular injections and 
medications to keep it under control. She does a lot of things right. 
She doesn't smoke, she exercises, and she follows her doctor's 
recommended diet. Other than her regular medications, she lives a 
normal, healthy life, and she is looking forward to retiring in the 
near future with her husband. They have been working hard their whole 
lives. They have been saving up for it. It is so close that they can 
almost taste it. But it is a dream that could be shattered by the 
Republican healthcare plan--the TrumpCare plan--being concocted 
secretly by 13 Members of this body. As she says:

       Without affordable coverage for pre-existing conditions I 
     cannot even switch jobs easily. If Medicare is reduced or 
     eliminated, as the GOP is trying to do, I may never be able 
     to retire . . . we should not now, or ever, eliminate 
     coverage for pre-existing conditions (or price that coverage 
     such that most of us will never be able to afford it).

  She is worried that changes that refer to Medicaid and the Oregon 
Health Plan will ruin her ability to retire and her ability to access 
healthcare.

  I don't know exactly what the President was briefed on that made him 
call TrumpCare ``mean'' and then speak in a very derogatory fashion 
about the bill from the House. I don't know exactly what he learned. I 
don't know if it was because he learned that folks on long-term care 
could lose that long-term care and Medicaid pays for more than 6 out of 
10 Americans who are in long-term care. I don't know if it was because 
he learned about preexisting conditions. I don't know if it was because 
he learned it would throw 23 million people out of the healthcare 
system. I don't know if it was because he learned this would have 
devastating consequences to rural healthcare because of the impact on 
the finances of clinics and hospitals.
  Whatever he meant, he was right. He was right to make that transition 
from a month earlier when he held a celebration at the White House 
because this terrific, wonderful bill had been passed by the House, and 
when he sobered up and discovered that it was a mean-spirited, hard-
hearted bill. But for all these reasons, no healthcare should be 
crafted and jammed through without deliberation. No significant bill 
affecting

[[Page S3623]]

the lives of Americans should be pushed through in this manner. 
Americans deserve better. They expect more from this Chamber than such 
a secret, callous, poorly informed process. They don't like that 
powerful special interests are meeting with the Senators in private--
those private 13--to develop a plan, because here is what they have 
heard:
  They know this bill gives huge tax breaks to powerful parts of the 
healthcare industry, that it gives huge amounts of money away to those 
who make medical equipment and huge amounts of money away to health 
insurance companies, meanwhile stripping healthcare from millions of 
Americans. They know it also gives a massive tax break to the richest 
Americans.
  So here we are with a bill that Trump has called ``mean,'' giving 
away the Treasury to powerful special interests, meeting in private 
with my colleagues, giving away the Treasury to the richest Americans, 
while on the other hand lowering the boom on our seniors in long-term 
care, lowering the boom on struggling and working families, lowering 
the boom on 20 million or so Americans who would lose healthcare, and 
lowering the boom on the clinics and hospitals that provide care for 
everyone.
  That is what they see: special favors for the powerful and thrown 
into the street the working and struggling families. That is morally 
wrong. That is wrong from a policy point of trying to improve the 
quality of life of Americans, and it is why every Senator here should 
absolutely say no to moving to this bill on the floor without a full 
month, at least, for committee deliberations and for the citizens of 
the United States to weigh in.
  That is the difference between what happens in a dictatorship with no 
deliberation and a democratic republic with a legislative process that 
values deliberation and openness. That is the difference. Which model 
do my colleagues support?
  Let's fight for the ``we the people'' vision of our Constitution, and 
let's fight for quality healthcare for every American, and let's say no 
to moving to any bill that hasn't had public deliberation and at least 
a full month of deliberation in this Chamber.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mrs. MURRAY. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mrs. MURRAY. Mr. President, I ask unanimous consent to speak for 6 
minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mrs. MURRAY. Mr. President, I want to thank all of my colleagues for 
their comments today on the damage TrumpCare would do. Democrats, 
patients, and families have been fighting back against TrumpCare and 
Republican efforts to jam it through Congress for months.
  I want to take a moment and recall some of the promises President 
Trump and Republicans made at the very beginning of this process 
because there truly is a Grand Canyon between President Trump's 
promises and the TrumpCare bill he has now admitted himself is 
``mean.''
  At the start, President Trump promised to provide insurance for 
everybody that was both cheaper and higher quality. When TrumpCare was 
introduced in the House, Secretary Price said that ``no one would be 
worse off financially'' under the law. And when Speaker Ryan was asked 
whether millions of people would lose their insurance coverage under 
TrumpCare, he said ``no.''
  Families were told again and again that TrumpCare would lower costs 
and keep people covered. As we know, TrumpCare would do the exact 
opposite. It will raise healthcare costs for people across the country, 
astronomically for those with preexisting conditions and for seniors, 
who could pay as much as 850 percent more in premiums. Medicaid would 
be gutted. Women and men would be unable to get care from the providers 
they trust and choose at Planned Parenthood. New mothers would pay as 
much as $1,000 more a month just to get maternity care. Tens of 
millions of people would see their healthcare coverage taken away.
  I could continue. And I want to be clear that those facts came from 
the nonpartisan, independent Congressional Budget Office.
  Unfortunately and unsurprisingly, when TrumpCare passed the House, 
President Trump ignored those facts and doubled down on his broken 
promises. He championed TrumpCare, calling it ``very, very well-
crafted.'' He promised to get TrumpCare through the Senate, predicting 
that it would be an unbelievable victory. His Secretary of Health and 
Human Services called this bill--which would take healthcare coverage 
away from 23 million people--a victory for the American people. Which 
people? Maybe President Trump. Maybe special interests who are going to 
get these massive tax breaks. But not the hundreds of thousands of 
people in Washington State who are rightly scared of TrumpCare or 
millions more across the country.
  Democrats have come to the Senate floor with story after story about 
how our constituents would suffer under this legislation, workers who 
would not be able to make ends meet between jobs without losing health 
insurance, seniors who know they will go bankrupt if TrumpCare becomes 
law, moms who stay up at night worrying about whether their child who 
has a preexisting condition will be priced out of coverage, patients 
fighting for their lives who are afraid that TrumpCare will kill them 
and who are literally begging Congress not to do this.
  To these patients and families, President Trump's decision to finally 
admit the incredibly obvious--that TrumpCare is ``mean''--doesn't begin 
to cover it. To them, that bill is a gut punch. It is the bottom 
dropping out. It could be a death sentence. And this is especially true 
because, as hard as Senate Republicans have tried to keep their version 
of TrumpCare secret, behind closed doors, and in back rooms, as often 
as some have made promises just like those President Trump and House 
Republicans were making to try to reassure their constituents somehow 
that the Senate version of TrumpCare would be somehow less mean, the 
truth is, we know the Senate version of TrumpCare will be just as 
damaging.
  Senate Republican leaders have already admitted that they expect 
their TrumpCare bill to mirror 80 percent of the House's. We have House 
conservatives writing letters to Senate Republicans making demands even 
meaner than many Senate Republicans want. And we all have a good idea 
how this is going to end up. ``Mean'' doesn't even begin to cover what 
TrumpCare would do to my constituents in Washington and to people 
across the country, but it is a start.
  I haven't said this often, but I hope Senate Republicans listen to 
President Trump. This is a man who knows about mean--from making fun of 
a reporter with disabilities, to belittling our friend the junior 
Senator from Florida, to even impugning the senior Senator from 
Arizona, a war hero. When President Trump says something is mean, that 
certainly means something.
  Mr. President, I hope they think about why he had to make that 
comment. They realize just how hard it will be to defend this truly 
appalling legislation, especially after it has been jammed through 
Congress, hidden from patients, and hidden from families without seeing 
the light of day. I hope they do what we tell preschoolers to do when 
they do something mean--apologize and make sure to do better next time. 
In Senate Republicans' case, that means dropping this effort to 
undermine families' healthcare once and for all and then joining with 
us to continue fixing healthcare for the people we serve by making 
healthcare more affordable, getting more families covered, and 
maintaining quality of care.
  Democrats have ideas. We are at the table. We are ready to get to 
work as soon as Republicans are. It is not too late to make the right 
choice. The wrong choice is far more than mean. If my Republican 
colleagues do continue down this deeply harmful path, they should know 
they will own every bit of the hurt they cause, and they will be held 
fully accountable.
  Mr. President, I yield the floor.

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