[Congressional Record Volume 163, Number 106 (Wednesday, June 21, 2017)]
[Senate]
[Pages S3669-S3672]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                         Healthcare Legislation

  Mr. CASSIDY. Mr. President, I am also here to comment, as Senator 
Cornyn has, on the state of play, if you will, and the repeal and 
replacement of ObamaCare. I think sometimes the American people feel 
like collateral damage as Republicans and Democrats go back and forth 
as to what is the best policy.
  I am a physician, a doctor who worked in a public hospital for the 
uninsured for decades before I went into politics. I guess from my 
perspective, the primary thing is not Republican versus Democrat, but 
that patient who is struggling to pay her bills, her premiums, or the 
fellow who can't afford medicine. What are we doing for them?
  There is a gentleman who went on my Facebook page--again, cutting 
through this kind of political noise. This is Brian from Covington, LA:

       My family plan is $1,700 a month, me, my wife and 2 
     children. The ACA has brought me to my knees. I hope we can 
     get something done. The middle class is dwindling away. Can 
     everyone just come together and figure this out?

  If that is not a plaintive plea of someone who is drowning under the 
cost of premiums for insurance, which he knows he has and, as a 
responsible father and husband, he will work to pay for--nonetheless, 
he says that he is being crushed by these high premiums.
  The American people need relief. We have to lower those premiums. I 
have always said, though, that whatever we do must pass the Jimmy 
Kimmel test; that is, to say that if Brian's wife or children or he 
himself has a terrible illness, there will be adequate coverage to pay 
for the care their family would need for that member of their family 
with that terrible disease. It kind of brings us to where we are now--
two aspects to what we are considering.
  By the way, when folks say that we are redoing one-sixth of the 
economy, that is not true. The Affordable Care Act, ObamaCare, again, 
attempted to address one-sixth of the economy that is healthcare. We 
are focused on the individual market, which is about 4 percent of those 
insured, and Medicaid. We are not touching Medicare. We are not 
touching the employer-sponsored insurance market. It is important to 
realize that this is not as comprehensive as the Affordable Care Act. 
It is something far more focused.
  Let's first talk about Medicaid. I am very concerned about what has 
been proposed for Medicaid, but also concerned about current law 
regarding Medicaid. Under the Medicaid expansion in the Affordable Care 
Act, States got 100 percent of all the cost of the patients enrolled 
for the first 4 to 5 years. As you might expect, States were quite 
generous in their payments for these patients as they contracted with 
Medicaid-managed care companies to care for them, so much so that those 
folks enrolled in Medicaid expansion. Taxpayers are paying 50 percent 
more than taxpayers are paying for those in traditional Medicaid. And 
States enrolled roughly 20 million people in the Medicaid expansion 
program. The combination of enrolling so many people in the Medicaid 
expansion program and paying 50 percent more than for traditional 
Medicaid means that when States finally have to foot 10 percent of the 
bill, which they will by 2020--when States have to finally foot that 10 
percent of the bill, they cannot afford that 10 percent.
  Unfortunately, under the Affordable Care Act, State taxpayers will 
not be able to pay what in California is $2.2 billion extra per year as 
the State's 10-percent share. Similarly in Louisiana, my State, our 
taxpayers--me, my colleagues, my friends, my neighbors--would be on the 
hook for $310 million per year. Our State is having a budget crisis 
because we can't afford $300 million. Now it is a $310 million 
recurring bill every year.
  One thing that is not said is that Medicaid expansion in its current 
format is not sustainable. We have to do something--again, to preserve 
benefits for that patient. We have to take care of that patient, but we 
have to make it sustainable, both for the Federal taxpayer and the 
State taxpayer. By the way, whoever is watching this is both a Federal 
and State taxpayer. You are getting caught both ways.
  Let me speak a little bit about the process. If you want to speak 
about Medicaid, we just laid it out. Let's speak a little about the 
process, as much has been said about it. I don't care for how the 
process transpired, but I certainly understand Leader McConnell's 
concerns that Democrats would not collaborate. I find that a sorry 
state of affairs.
  What do I mean by that? Susan Collins and I, and four other 
Republican Senators, put forward a bill that would allow Democratic 
States to continue in the status quo--to get the money they would have 
ordinarily received under the Affordable Care Act and to continue a 
system--as much as they desire to have--for the whole Nation.
  The minority leader, Chuck Schumer, condemned our bill before we 
filed it, meaning before he had a chance to read it. Without reading 
our bill, he condemned it, even though his State of New York would have 
been allowed to continue in the program that they are currently in and 
receive the dollars to support that program. He condemned the bill 
before he read it, even though it would have allowed his State to 
continue in the status quo.
  Similarly, we approached other Senators--10, at least, on my part. 
None would help us with our bill, even though their State could have 
continued in its current status quo, receiving the income it currently 
receives. That tells me that even a good faith effort to reach across 
the aisle was not going to get cooperation. That is too bad, and that 
is why, I think, there is kind of a political back-and-forth in which 
the patient--the American like Brian, struggling to support and cover 
his family--gets lost in the crossfire. A goodwill bill, designed for 
States to do that which they wish to do, would not even be considered 
by the other side.
  I have always pointed out that if even two Democrats had walked into 
Mitch McConnell's office and said ``We will work with you to pass a 
bill,'' they could have gotten far many more things for their State 
than saying ``No, we have not been invited to the party; therefore, we 
will not participate.'' I say that as an observation, not as a 
criticism, but also as an explanation to the American people of how we 
have ended up in this position.

  Now, as to the bill that will be before us, I have not seen the 
written language. I reserve judgment until I have seen that, but I will 
say that there are some things I like. If our desire, again, is to take 
that patient, the American citizen, and make sure his needs or her 
needs are met--a family such as Brian described here who cannot afford 
their current premiums--there are things in this bill which will lower 
those premiums. There is the so-called cost-sharing reduction payments 
for the next couple of years that would continue to provide certainty 
to the insurance companies so that when they market insurance on the 
individual market, there would be certainty. They would be able to know 
those dollars are coming from the Federal taxpayer to support folks for 
the next couple of years, and they could lower their premiums 
accordingly.
  There will be a so-called State Stability Fund that going forward, 
States

[[Page S3670]]

could use to create what was called the invisible high-risk pool--a 
reinsurance program, if you will--so that if you are a patient on 
dialysis, a patient with cancer, very expensive to care for, you would 
continue to get the care you require, but everyone else in that 
insurance market has their premiums lowered because there is a little 
bit of help for those folks with those higher cost conditions. By that, 
we lower premiums.
  President Trump, when he was running for President, said he wanted to 
continue coverage, care for those with preexisting conditions, 
eliminate the ObamaCare mandates, and lower premiums. What I have seen 
or, at least, heard is we are on the path to fulfilling President 
Trump's pledge. Now, again, reserving judgment until I have seen 
written language, I will say that what I have seen so far keeps the 
patient as the focus, would address someone like Brian, the needs of 
his family, the needs of their pocketbook as well as their health, and 
build a basis so that going forward, States would have the ability to 
innovate, to find a system that works best for them.
  On behalf of those patients, I hope that we as a Senate--whatever our 
party--are successful. I hope going forward we, as a Senate, no matter 
what our party, put the patient as the focal point, hoping that our 
combined efforts--again, no matter what our party--will address her 
needs or his needs, both financially and particularly for their health.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. BLUMENTHAL. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered
  Mr. BLUMENTHAL. Mr. President, earlier this week, on Monday morning 
at 9 a.m., I held a last-minute emergency field hearing on healthcare. 
With our colleagues on the other side of the aisle refusing to hold any 
official hearing on the bill and refusing to even show us the bill--
what almost certainly is almost bad policy that is contained in the 
bill--I wanted the people of Connecticut to know that their voices and 
their faces would be heard and seen here in Washington, DC, and their 
stories would be told with or without an official committee hearing.
  When I say this emergency field hearing was last minute, it was truly 
last minute, with many people having not even days but hours of advance 
notice to come and speak and share with me and others what the 
Affordable Care Act has meant to them, to their families, to their 
communities, and what losing it would mean to them.
  To say the room was full would be a gross understatement. Every seat 
was filled, and when those seats were gone, people lined the wall two 
or three deep and squeezed in through the door. They were so anxious to 
be heard, and they were loud and clear. They were heard by me, and now 
I want their voices to be heard here.
  We are continuing this hearing. In fact, we are having a second 
hearing on Friday afternoon at 1:30 in New Haven. We are sending out 
notices, blasting them to the people of Connecticut. We will have a 
third, if appropriate and necessary.
  The people who came to this emergency field hearing in Connecticut 
were no different from millions of other people around the country, and 
they were speaking, in a sense, for all Americans. In my mind, they 
were speaking for parents who are suffering, providers who are healing, 
kids fighting back against dreaded diseases. They came because the 
closed-door discussions held in secret here by a small number of 
colleagues across the aisle will impact them every single day for the 
rest of their lives. My constituents and the people of Connecticut and 
the people of the country are unrepresented in those discussions. That 
is a travesty and a betrayal of our trust and our job.
  So, on Friday, we are going to do the same thing. We are holding 
another emergency hearing in New Haven so people of my State can be 
heard, despite this disgraceful process that has left them and so many 
others on the outside looking in. They are excluded from democracy, and 
that is unconscionable.
  If nothing else, I hope my colleagues will realize one thing. This is 
what democracy looks like. This is how we are meant to make decisions 
with many opinions--much debate, diversity of viewpoint, sometimes 
messy but always transparent, open, and clear to people whose lives are 
affected by it. That is what this emergency field hearing was designed 
to do.
  Since it is becoming increasingly clear that this bedrock principle 
of our democracy--the right to open and honest debate--is being denied, 
I want to share some of the stories I heard on Monday, just some of 
them, and I will be sharing more of these stories over the coming days.
  Justice Brianna Croutch was described by her mother as a beautiful 
free spirit, as you can see from this side of the photo. She was filled 
with compassion and at 21 years old had a beautiful and meaningful life 
ahead of her, all of her life ahead of her. She was a full-time student 
in a dental program, and she had a 4.0 average.
  Justice, like far too many people, particularly young people in 
Connecticut and around the country, had a substance use disorder, and 
she needed effective, long-term treatment to begin that road to 
recovery. For Justice, this treatment came too late, and on August 23, 
2015, she overdosed on heroin. It led to a brain injury. It is likely 
she will never recover from that injury.
  ``More likely than not,'' her mother said, ``I will have to make the 
decision to bring my daughter home with hospice care. No parent should 
be faced with these decisions.'' That is what Jennifer Kelly said at 
the hearing on Monday.
  That is a picture of Justice as she is today.
  I want to read exactly what Jennifer Kelly said because her words are 
far more powerful and meaningful than mine could ever be.

       The American Health Care Act--

  The House version of the so-called replacement for the Affordable 
Care Act--

     would reduce Medicaid funding by $800 million, which provides 
     coverage to an estimated 3 in 10 adults dealing with an 
     opioid addiction. This will be so devastating to those 
     seeking treatment for an opioid addition. In a system where 
     families are already seeking help, this will be a tremendous 
     step backwards.
       So here I am, almost two years later, pleading for life, 
     fighting once again for families I have never met, because I 
     believe that no one should have to fight to get help for 
     addiction in this country like my daughter did. So my 
     question is, Mr. President and the members of the Senate, 
     what number of lives lost will be enough? What is the magic 
     number of sons and daughters, mothers and fathers, aunts and 
     uncles that we as a nation will have to lose before you 
     realize this country needs help?

  I ask that same question of my colleagues today. I ask the question 
that Jennifer, a brokenhearted mother, asked. What number of lives will 
be enough? How many is enough? When will others in this body realize 
that gutting our healthcare system and stripping millions of care will 
simply make this opioid epidemic worse?
  Jennifer was unfortunately not the only person who came to speak 
about the opioid epidemic. For me, the most moving and powerful among 
those moments came from Maria Skinner, who runs the McCall Center for 
Behavioral Health in Connecticut, who was there to give her thoughts 
and share the stories of two young people. I was actually lucky enough 
to meet both of them. Once again, I am going to share her words 
directly:

       What I want to do is talk to you about two people and make 
     that a real, personal, granular, human story. . . . And you 
     know these two people very well; it's Frank and Sean.

  She was speaking to me.

       [You] have met Frank and Sean, who were able to access care 
     and get clean and sober because of the Medicaid expansion, 
     because they were able to have coverage.
       And they've come here, to these rooms, to speak 
     courageously and publicly about their struggle and about 
     their recovery, and about how grateful they are to be able to 
     be clean and sober because of the access of care afforded 
     them through their insurance coverage.
       We went to Sean's funeral on Saturday, and . . . Frank 
     would be here today if he wasn't as brokenhearted as I am. 
     Sean was 26 and had been doing really well, was on 
     Naltrexone, was taking a Vivitrol shot, and he had to have 
     surgery for a hernia, because

[[Page S3671]]

     he raced motorbikes professionally and the hernia hurt him. 
     He wanted to go back and was doing so well, he was speaking 
     publicly to youth and was anxious to go back into doing what 
     he loved. So he had that surgery and had to come off of his 
     medication to do that. He was very vulnerable after his 
     surgery, and he slipped once, and he used.
       I've been to too many funerals and seen too many mothers 
     and fathers brokenhearted at the coffins of their sons and 
     daughters. We can't make this any harder than it already is. 
     To me, it is unconscionable.

  Maria is right, and so is Jennifer. Gutting Medicaid would be 
unconscionable. Weakening the protections afforded to those with mental 
health or substance use disorder would be truly unconscionable. 
Repealing the Affordable Care Act and the provisions within it that 
have meant more coverage, more healthcare, and more healing for those 
suffering from substance use disorder and struggling to break the grip 
of this opioid epidemic would be unconscionable and costly beyond 
words.
  Alternative funds, as some reports say Republicans have considered, 
will never replace a permanent insurance program like Medicaid because 
Medicaid guarantees that coverage is there when families need it. No 
alternative can do that.

  In Connecticut, nearly half of all medication-assisted treatment for 
people with substance use disorders is paid by Medicaid. My fear is 
that the Republican bill in place will mean that these people would 
have no place to go. They would have no support for medications, 
counseling, and help, no chance to get better, no place to go. I refuse 
to let us find out the answer to what would happen to them if Medicaid 
were gutted. I refuse to allow it to happen, if I have anything to do 
with it.
  People with substance use disorder are not the only ones who will see 
their coverage threatened by a weakening of protections for those with 
preexisting conditions. In Connecticut on Monday, Shawn Lang of AIDS-
Connecticut expanded on what this bill would mean for the people living 
with HIV in this country.

       Some of us lived through the early days of the plague when 
     we went to funeral after funeral, memorial service after 
     memorial service, week after week, month after month, 
     watching our friends wither away and die. The healthcare bill 
     that is currently secretly weaving its way through Congress 
     would bring us back to the early days of the plague.
       HIV is a preexisting condition. Over half of the people 
     living with HIV in the country and in this state are over the 
     age of 50 and rely on Medicaid as their primary source of 
     insurance. Most of those people also have other co-
     morbidities like substance abuse disorders and mental health 
     disorders. What little we know about this bill would be 
     devastating to people with HIV and AIDS, and it essentially 
     would amount to a death sentence. Once again, having lived 
     through those early days, we don't want to go back there.

  Shawn's story is one of many I heard about the fear of losing 
coverage due to a preexisting condition.
  Gay Hyre, a 60-year-old breast cancer survivor, has similar concerns 
about what gutting the Affordable Care Act would mean not just for her 
but for everyone around her. She said this about why she came to speak 
at the hearing:

       I'm not just worried for me about my own care, although I 
     will be on the receiving end of a lot of bad parts of this. I 
     care passionately about the other 23 million Americans who 
     are my fellow citizens of every age, type, and need. It's 
     about the future, it's about our kids, it's about our 
     grandkids who won't have access to treatments, who won't have 
     access to doctors.

  I know my colleagues across the aisle don't want to hear these 
stories. If they wanted to hear these stories from people in 
Connecticut and around the country, millions of stories, we would have 
hearings--not just emergency field hearings; we would have hearings 
here in Washington before the Committee on Health, Education, Labor, 
and Pensions and before the Committee on Finance and other committees 
that have jurisdiction on the House side as well as in the Senate. We 
would be having a real debate, a robust discussion, and everyone of us 
here would have a chance to review this bill, if there is a bill, and 
comment on it and hear from the people we represent. But unfortunately 
my colleagues across the aisle don't want to hear about the details of 
repealing the Affordable Care Act.
  One witness at my hearing, Ellen Andrews of the Connecticut Health 
Policy Project, really summed up the reason. Here is what she said:

       We have been working on expanding health coverage, high-
     quality, affordable coverage to everyone in the state and now 
     everyone in the nation. I looked back, actually, at 2010, how 
     many people were uninsured in this state before the 
     Affordable Care Act, it was 397,000 people, almost 400,000. 
     Last year it was down by 262,000. That is 262,000 fewer 
     people living in our state without insurance because of the 
     Affordable Care Act.

  I want to share one final story. It is about a little boy in 
Connecticut who has a lot to lose if the Affordable Care Act is 
secretly gutted behind closed doors, as is now happening in real time 
right before our eyes, in secret, invisibly, in this body. I want to 
tell you about Connor Curran.
  Two years ago, when Connor was 5 years old, his parents noticed that 
he was lagging behind his twin brother. They brought him to a doctor. 
Rather than receiving a simple diagnosis, they learned that Connor has 
Duchenne muscular dystrophy, a degenerative terminal disease that has 
no cure. Most people with the disease don't survive past their 
midtwenties. Connor's family wrote that their sweet boy, who was just 5 
and full of life, would slowly lose his ability to run, to walk, to 
lift his arms. Eventually, they said, he would lose the ability to hug 
them at all.
  Connor needs complex care from multiple specialists, costing an 
estimated $54,000 a year. Thanks to the Affordable Care Act, he cannot 
be denied coverage and has the coverage he needs to receive care. His 
family also wrote that any elimination of lifetime caps or elimination 
of essential health benefits will hinder his family's ability to access 
the care that Conner needs.

  This is Conner in a picture that has been provided by his family.
  The ACA removed barriers to Conner's care, and they are concerned--
and so am I--that this reckless, reprehensible bill will put them back 
to the place that they were when they first learned about Conner's 
diagnosis.
  Should Conner's disease progress, he will very likely need access to 
Medicaid in order to offset the costs of living with a disability, but 
for his family, the question now is, Will Medicaid even be there? If 
that devastating day comes, will he continue to receive the care he 
needs?
  Conner's family is not about to give up. They have come to my office 
annually since he was diagnosed in order to fight for a cure and to 
fight for the Affordable Care Act--sometimes with tears in their eyes. 
They raise awareness, and they fight for their little boy. I know they 
would do it a million times over again if it meant that Conner could 
get better and live a long and healthy life.
  Conner and others like him are why I am here. Conner and others like 
him are why I will continue this fight against any attempts to repeal 
the Affordable Care Act and replace it with a shameful, disgraceful 
bill that has been written behind closed doors--destroying lives and 
degrading the quality of life for millions of Americans.
  The people whom I have met in Connecticut who came to this hearing--
and countless others who have talked to me about the Affordable Care 
Act--are fighting for their lives and their health and for others who 
need it as well.
  Those people whom I met in Connecticut and the others who will come 
to our hearing on Friday and, perhaps, afterward are the reason I am 
fighting for better coverage for all of the people of Connecticut and 
our country.
  Those people are the best of our country with their fighting spirit 
and dedication to the people they love, and they deserve to be heard. 
They are the voices and faces of the Affordable Care Act who have been 
turned away at the door of this Capitol. I refuse to allow them to be 
silenced.
  As I have mentioned, we will be back at it again on Friday because 
hearing from our constituents is part of our job. It is the bedrock of 
democracy. It is the fundamental core of what we do--listening to the 
people whom we represent. Failing to do so is unconscionable just as 
destroying the Affordable Care Act would be unconscionable, just as 
denying Conner what he needs would be unconscionable, just as ignoring 
Justice and Sean and Frank would be unconscionable. I hope my 
colleagues will listen.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Utah.
  Mr. HATCH. Mr. President, I am pleased to yield 5 minutes to the 
distinguished Senator from Georgia.

[[Page S3672]]

  The PRESIDING OFFICER. The Senator from Georgia.
  Mr. ISAKSON. Mr. President, I thank the distinguished President pro 
tempore of the Senate, the chairman of the committee. I am honored to 
take that 5 minutes.