[Congressional Record Volume 163, Number 107 (Thursday, June 22, 2017)]
[Senate]
[Pages S3703-S3707]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
Healthcare Legislation
Mr. MARKEY. Mr. President, last week, President Trump reportedly told
several of our Republican colleagues that the House-passed version of
TrumpCare's healthcare repeal of the Affordable Care Act was mean. This
week, White House Press Secretary Sean Spicer said that the President
would like to see a healthcare bill from the Senate that ``has heart in
it.'' What did we get? We got a bill from my Senate Republican
colleagues that is identical to and in some cases even worse than the
disastrous House-passed American Health Care Act that would rip
coverage away from 23 million Americans and gut Medicaid by more than
$800 billion.
Nothing changes the fact that this undemocratic, secretive process
has resulted in legislation that is so mean-spirited, it would make the
Wicked Witch of the West cringe. The Senate Republican bill will rip
away economic security from young families, make grandma and grandpa
pay more for health insurance simply because they are old, tear away
coverage for opioid addiction patients desperate for treatment, and
punish Americans with preexisting conditions such as cancer, diabetes,
and Alzheimer's. For once, I agree with President Trump. This bill is
mean.
Let's take a closer look about what is really inside of the Senate
GOP's proposal on healthcare. Let's start by looking at the lower
quality coverage. First, this bill will roll back the clock to the days
before the Affordable Care Act, when an insurance card did not
guarantee comprehensive coverage.
Because of the Affordable Care Act, there are certain things an
insurance plan just has to cover--things like emergency services,
maternity care, prescription drugs, mental health services. There is
security in knowing that if you pay your premiums, this sort of basic
minimum coverage is in place when you need it. But Republicans want to
rip that away. They want to give States and insurance companies the
option to not cover these things. This would make it so that a consumer
could easily be faced with an unexpected medical bill for services they
had assumed were covered with their healthcare plan.
Independent analysis from the Congressional Budget Office estimates
that out-of-pocket costs for maternity care or mental health or
substance abuse disorder services could increase by thousands of
dollars in a given year under TrumpCare. That is not increasing
quality, as President Trump promised; that is lower quality. And that
just increases inequality between the healthy wealthy, who can pay out
of pocket for their care, and providing lower quality coverage for
everyone else. That is mean.
Second, an age tax. Since the Affordable Care Act became law, the
uninsured rate for Americans ages 50 to 64 decreased by one-half. Those
are the baby boomers, and it is estimated that more than 28 million of
these baby boomers will develop Alzheimer's disease between now and the
year 2050. This reduction in the uninsured rates came about because the
Affordable Care Act expanded Medicaid and put protections in place to
prevent insurers from charging exorbitant prices just because of age.
But instead of caring for our family and friends as they age and
ensuring they can afford quality coverage on what may be a dwindling
income, TrumpCare punishes you for achieving your milestone 50th
birthday.
Under the Republican healthcare proposal, insurance companies can
charge older Americans five times more than younger Americans for the
same coverage. That is unconscionable. It doesn't matter if you are a
50-year-old marathoner in the best shape of your life; you will still
be paying at least five times more for your insurance than your 40-
year-old neighbor who smokes. As a result, Americans over the age of 60
could see their premiums increase by an average of $3,200 or 22
percent. That might not sound like a lot to some people, but for those
with decreasing incomes and fewer job opportunities, it is the
difference between being able to eat and being kicked out on the
street.
To add insult to injury, the subsidies in TrumpCare to help
individuals purchase insurance are far less generous than what is
currently available under the Affordable Care Act. Because that will
result in premiums that are higher, the tax credits will not keep pace
to help pay for more expensive insurance, and, as a result, this age
tax is going to be mean to those who are older in our country.
No. 3, Medicaid cuts. Medicaid is a lifeline for families across our
country. More than 70 million Americans--nearly half of whom are
children--depend upon it. But it is clear that with TrumpCare's cuts to
the program, Republicans want Medicaid to flatline. For a program that
covers more than one-fifth of the Nation's population, including the
sickest, the oldest, and the
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poorest amongst us, Medicaid is especially irreplaceable.
But Republicans harbor an ancient animosity toward Medicaid.
Republicans say that we need to restructure Medicaid's financing to
help control the program spending and make it more efficient. That is
just another way of saying to America's most vulnerable that you are
just not as important as those who donate to our campaigns.
Raiding the Medicaid coffers achieves two goals. First, it tears
holes in a critical social safety net for more than 70 million low-
income and working-class Americans. Second, it provides the GOP with an
open checkbook to pay back their donors with huge tax breaks.
Republicans might want to refer to these changes as capping the
Medicaid program, but don't be fooled. What capping really means is
decapitating access to primary care, decapitating the ability of
grandma and grandpa to secure a nursing home bed, and decapitating
access to treatment for substance abuse and mental health conditions.
Gutting the Medicaid program--that is mean.
Next, they are going to reduce access to care. This one is simple.
Less insurance coverage equals less access to care. While it is
possible to get a doctor's appointment and treatment without health
insurance, it is usually at prices that are impossible to afford for a
typical uninsured person. Most working Americans can't conceive of
paying more than $150 every time they want to visit a primary care
doctor or footing the bill for a couple of thousand dollars in the
event they need more specialized care. The best medicines and the most
effective treatments are only as good as the insurance coverage people
have to help them to access to it.
How will these 23 million Americans who lose insurance under
TrumpCare get the care which they need? They will not get the care.
Unfortunately, when patients do try to access care, it will be because
their illness has progressed to the point where it can no longer be
ignored. Instead of seeking care with a primary care doctor in a less
expensive healthcare setting, most uninsured patients will end up going
straight to the emergency room--the most expensive site for care. And
the cost of that uninsured patient--well, that is just going to get
absorbed by everyone else in our country, as our rates for treatment
and insurance coverage increase to make up for this uncompensated care.
So reduced access to care--that is mean.
Then we move on to higher premiums. Higher premiums are going to be
the new rule in our country because that is going to be what happens if
the Republicans are successful in repealing the Affordable Care Act.
According to the nonpartisan Congressional Budget Office, TrumpCare
would increase premiums by an average of 20 percent in 2018. In
Massachusetts alone, premiums for next year could increase by $600,
threatening coverage for more than 180,000 of my constituents with
private insurance. Because of everything else in TrumpCare, even though
you are paying more, you will be getting less. It is like paying for a
Cadillac, but only getting a tricycle. This will only prevent Americans
from securing access to the care and the treatment they need and they
deserve. Less care for more cost--that is going to be mean. Premiums
are going to go up for everyone.
Finally, it threatens all of those in America who have preexisting
conditions. For so many Americans, allowing insurance companies to
refuse coverage or charge more because of a preexisting condition is
inhumane, and it is immoral. Anyone who tried to buy individual health
insurance before the Affordable Care Act remembers this problem. Before
the healthcare act passed, in most States, if you had a preexisting
condition, you could either be denied coverage, charged a much higher
premium, or forced to wait potentially for years before receiving
treatment for the condition to be covered. For many people, this meant
they either had to go without needed care or spend their entire
savings. For those with the most serious conditions, it was the
difference between life and death.
The anxiety of suffering from an illness was only exacerbated by
financial insecurity. It was a cruel and unusual form of punishment.
Sadly, the Republicans want to take us back to this era. Threatening
preexisting conditions--that might be the meanest of them all because
protections for families who have preexisting conditions is something
that goes right to the heart of what the Affordable Care Act provided
as a protection.
Why would millions of Americans have to suffer these cruelties, these
indignities, these punishments? That is the most outrageous part of all
of this. President Trump and the congressional Republicans are
proposing this healthcare heartlessness, all so they can give tax
breaks to the wealthiest in our country.
We heard it from President Trump himself last night when he talked
about the people he hired for his Cabinet. ``I just don't want a poor
person,'' he said. But who does he want running the government and our
economy? He wants the wealthiest people in America. He wants people who
are billionaires to be making the decisions as to how we run our
economy. President Trump has in place a goal of turning over to the
richest people in our country the responsibility for putting together
the plan to cut the programs for the poor and the working families in
our country.
The Republicans and their wealthy planners have put together a very
simple one-step program: The rich get richer, and the rest get sicker
in the United States. Make no mistake, this healthcare plan is of the
rich, by the rich, and for the rich. It is giving billions in tax
breaks to people who don't need or deserve them, paid for by people who
can't handle or afford it. That is cruel, that is inhumane, that is
immoral, that is just plain wrong, and my Democratic colleagues and I
will not stand for it.
We are standing up to say no to ripping away coverage for millions of
Americans. We are raising our voices to say no to increasing costs for
middle-class families. We are saying here today that we are going to
say no to this legislative malpractice. The health of the American
public is too important for us to be so mean, so callous to the people
we were elected to serve.
This Republican proposal has never been about policy. It has always
been about politics, and it is time to stop playing political games
with people's lives, with people's healthcare.
Healthcare is a right and not a privilege. That is the promise we
made to the American people with the Affordable Care Act, and it is a
promise we must keep.
The President is keeping his promise to the rich in our country. They
have now written a healthcare plan for one-sixth of our economy that
slashes $800 billion that would be used for the poor, for the sick, for
the working class, for senior citizens in nursing homes by $800 billion
in order to give an $800 billion tax break to the wealthiest people in
our country. That is wrong.
This is a critical moment in our country's history, and we, as
Democrats, are going to battle every single day here on the Senate
floor and across this country to make sure that every person
understands what the consequences of this incredibly callous, mean bill
will mean--lower quality coverage, an age tax on the elderly, Medicaid
cuts that hurt families across our country, reduced access to care,
threatening of the protections for preexisting conditions, and
resulting in higher premiums for everyone. It will be a disgrace.
I yield the floor.
The PRESIDING OFFICER (Mrs. Fischer). The Senator from Maryland.
Mr. CARDIN. Madam President, first I want to thank Senator Markey for
his comments. I share his concerns. I agree with what he has said about
the risk factors of the bill that was announced this morning by the
Republican leader and what it could do to millions of people around
this country and what it will do to coverage for hundreds of thousands
of people in my State of Maryland who will lose coverage and just about
every Marylander whose healthcare will be impacted if this bill were to
become law.
I want to start by saying that I think this is a shameful moment for
the Senate--the Senate, whose traditions have made it be known as the
most deliberative body in the world; the Senate, which has been known
as a body that
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allows for robust debate and benefits from the views of all 100
Members, where each of us has opportunities to get our voices heard.
That tradition has been badly damaged by what the majority leader has
done in bringing a bill that affects one-sixth of the economy of our
country to the floor of the Senate without the deliberation by our
committees and without transparency to the American people.
When I got to the Senate, I worked hard to get on the Senate Finance
Committee. I did that because the jurisdiction of the Senate Finance
Committee contains areas that I have devoted a good part of my public
career to, including issues of taxation and issues concerning social
programs in our State. But it also included healthcare, an area that I
worked on when I was first in the Maryland State legislature. I wanted
to be on the committee that had a role in developing the health policy
of this Nation. I thought I could add to that debate with my
experience, and I wanted to make sure that the people of Maryland had a
voice as we developed healthcare policy in America.
That role is being denied by what the Republican leader is doing in
bringing this bill to the floor without the benefit of hearings. Let me
just repeat that. There has not been one hearing held on the
legislation being brought forward by the majority leader. There hasn't
been one committee markup of the bill.
Now, let me explain to the general public what a markup is. It is
when the committees that have expertise on a bill--in this case, it
would be the Senate Health, Education, Labor, and Pensions Committee
and the Senate Finance Committee--have had a chance to bring the public
in to get their views on the legislation, have had the committee staff
go through it and explain all of the aspects to the members of the
committee, with an opportunity for us to offer amendments to improve
the bill, and then, ultimately, taking a vote on the recommendation to
the full Senate. That is the regular order, but it is particularly the
regular order on complex pieces of legislation.
I don't think there is a Member of this body who would say that this
is not a complex field when we are dealing with healthcare--one-sixth
of our economy. But the process that was used denied the people of
Maryland and the people of this Nation the opportunity to have their
voices heard through their elected representatives. It is a shameful
moment.
Now, I know this has been done before on the floor, but I will just
repeat it one more time. Compare this to how the Affordable Care Act
was passed by the Senate. We had transparency, opportunities for the
public to have input. We had hearings--many, many hearings that took
place. My staff tells me there were 50 hearings or roundtable
discussions or walk-throughs. We had 26 consecutive days of Senate
debate. There were hundreds of amendments offered by both Democrats and
Republicans that were adopted on the bill before the bill reached the
floor of the Senate. That all took place before we started the debate
on the bill.
You cannot justify this process. This is an abuse by the majority,
and it will affect the functioning of the Senate.
There are concerns about what this bill will do. The process is
terrible. The impact on the Senate is terrible. But the real tragedy
here is the impact, if this bill were to become law, it would have on
healthcare in America.
So let me talk a little bit about my State of Maryland. It has been
projected under this bill that those who will not have insurance
coverage will go back basically to what it was prior to the passage of
the Affordable Care Act; that is, a little over 400,000 Marylanders are
at risk of losing basic health coverage. Now, it is going to affect
everyone with insurance in Maryland, and I will get to that in a
moment. But as many as 400,000 people are in jeopardy of losing their
insurance because of what is done with regard to the alliances and the
Medicaid Program itself. Many more will lose quality coverage.
Senator Markey talked about preexisting conditions. You claim that
there is protection for preexisting conditions, but it does not
guarantee that the services will be provided because the States are
given tremendous discretion as to what would be required as essential
benefits within the healthcare plans. So if someone has a mental
illness or someone has a drug addiction, is there a guaranteed coverage
that that person would be able to get services? If that person has a
preexisting condition, it may very well not be covered because of the
absence of essential health benefits.
Let me just give you another example of what could happen under this
bill, and this is a real example on gender discrimination. Obstetrics
coverage is critical for a childbearing woman. Now, if that becomes an
optional coverage because of the State plans and discretion that it is
given, obviously only those women who are planning to have children
will take that coverage. Why would someone who doesn't need that
coverage take the coverage? What are the consequences of allowing that
type of choice? It is very clear.
Younger women are going to pay a lot more for their health insurance
than they otherwise would. Is that fair? I think not. I think not. That
is the consequence of the type of changes that are being made in the
Affordable Care Act.
I was very instrumental in making sure that we had full coverage for
pediatric dental. Why? Well, unfortunately, in my State in 2007--the
year I first started in the Senate--we had a youngster, Deamonte
Driver, who lived not far from here, who died because of an untreated
tooth decay. It became abscessed and went into his brain. He had to go
through a couple of surgeries, and he lost his life. What was needed
was $80 of dental care. He couldn't get access to it because there was
no coverage for it. He had no access to that care. He lost his life
and, of course, the healthcare system had to pay a lot of money when it
only needed to spend $80 to keep him healthy.
Well, we took care of that and fixed that with the essential benefits
now, including pediatric dental. Is that protected under the Republican
bill? The answer is unclear--probably not. It is up to the States. It
may be different in one State versus another. We don't have the
protection.
Then we get to the affordability issue for Marylanders to be able to
afford to have health insurance. Under this bill, there will be
discrimination on those that are older. They are going to have to pay
more for their health insurance. Is that right? No, it is not right. I
heard the majority leader this morning give examples of how the
Affordable Care Act is in danger, and he cited high premium increases.
One of the States he quoted was the State of Maryland, and it was very
misleading the way he did that. He was talking about the individual
marketplace, and he was talking about one segment of that. What he
didn't tell you is that CareFirst, the insurance company that is
proposing that rate increase, indicated that at least half of that
increase is the result of action taken by the Trump administration,
because the Trump administration has not made it clear whether they
will fund the cost-sharing provisions, which keep the costs down and
affordable in the individual marketplace. That is a self-inflicted
increase in premiums by the Trump administration.
There is a second issue that CareFirst mentioned, and that is the
President's insistence on not enforcing the individual mandate, and, by
the way, that is in the Republican bill. It means that younger,
healthier people will choose not to have health insurance. Now, if they
happen to ride a motorcycle and wrap themselves around a tree and get
flown to the Shock Trauma Center in Baltimore and we are going to treat
him, guess who is going to pay the bill? All of us are going to pay the
bill through uncompensated care. It is going to raise my insurance
policy and everybody's insurance policy. That person should have had
insurance, but that person thought he or she didn't need that
insurance. So they didn't take out the policy.
You find that those who will take out the insurance policies are the
higher risks because they know they need the insurance. So those with
high-risk issues will be in the pool raising the costs and that is why
CareFirst has a higher ask, because they know it is less likely that
healthier people will be in the pool than projected under the original
Affordable Care Act. Why? Because of President Trump.
So when the leader says that the Affordable Care Act is falling
apart, the
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Affordable Care Act is strong, but it has been made vulnerable by the
actions of the Trump administration, and the provisions in this bill
will make it even weaker.
Now, 1.2 million Marylanders are in our Maryland Medical Assistance
Program, or Medicaid Program. Many of these people are working
families. Many of these people are our seniors who need long-term care
and are in the Medicaid Program because it pays for their long-term
care expenses. Many of these people are veterans or returning warriors
who are under the Medicaid Program.
Under the Republican-released bill, they may make it a gentler slope
before we get to the full impact of the Medicaid reductions, but the
Medicaid reductions, if I understand correctly, are even more severe
than under the House-passed bill.
Now, I could speak for Maryland. I know our legislature. Our
legislature is going to try to do what is right, but they have limited
resources in order to try to meet the needs that are out there. It is
just not right to say that we are passing these problems on to the
States when the States don't have the fiscal capacity to deal with
them. Who gets hurt? The 1.2 million Marylanders who rely upon the
Medicaid Program and all Marylanders who don't want to see what we call
cost shifting, when someone who doesn't have health insurance ends up
in our emergency room and doesn't pay the bill and everyone else pays
those bills.
So why are we doing this? What is the reason we have gone through
this pain? I have heard my colleagues talk about it, and it is
absolutely true. The Republicans need to make room for the tax cut.
They are pretty clear about it. Close to $1 trillion in tax cuts is
what they need to do. Who benefits from tax cuts? The wealthy, those
who have access to healthcare. Who pays for the tax cuts? Those who are
the most vulnerable in our community. That is just wrong.
My staff has put together a lot of individual letters that have been
sent to us. I don't even need to go through them. I can tell the
Presiding Officer just the experiences I have had walking on the
streets to Baltimore or, quite frankly, walking anywhere, including
here in Washington.
When people come up to me and say: Senator Cardin, keep up the fight.
Do you know what is going to happen if that healthcare bill becomes
law? We have done some tests and we have certain genes, we are in a
high-risk pool for cancer. We are not going to be able to get coverage
if you let insurance companies go back to the practices they had before
the passage of the Affordable Care Act.
People say that if they didn't have the insurance they now think they
are going to lose, they would have to go through personal bankruptcy.
That is not a hypothetical. Before the passage of the Affordable Care
Act, unpaid medical bills was the leading cause of bankruptcy. Are we
going to go back to those days?
I talked to a parent who has a child with a disability--and to think
what the cost of that child is going to be in the healthcare system.
They don't possibly have the means to be able to afford that if they
didn't have access to healthcare coverage without discrimination. You
leave these discretions to how the insurance companies will respond
with their businesses, they are going to figure out a way so a family
who has a disabled child will not have adequate coverage. That is what
is at risk. Senator Markey is right--healthcare should be a right, not
a privilege, and we are moving in the wrong direction.
In Maryland, we have hospitals that are located throughout our State
to meet the needs of the people of Maryland. We have hospitals that are
located in areas where they have a lot of elderly and a lot of poor
people, but because of the way we deal with our hospital
reimbursements, we don't have cost shifting. We can have what is known
as an all-payer rate, where whoever goes into the hospital, they pay
the same rate so a hospital can locate in an inner city or poorer
neighborhood. If you increase the cost sharing for people who don't
have insurance, hospital facilities will not locate in those
communities, adding to the costs of everyone's healthcare.
One of the great benefits, one of the great achievements of the
Affordable Care Act, is that we now have facilities that are more
conveniently located to people in this country, whether they live in a
rural area or urban setting. Some are healthcare centers and some are
health clinics, but they are more conveniently located because more
people have third-party coverage and have insurance in order to pay
those bills.
So I read with interest that certain segments of the advocacy
community are going to be given certain concessions in this bill, and
they think they are going to be OK. One is, I understand--and I am not
sure what this term means, and maybe someone can explain it to me--
medically complex children. These are children, I assume, who have
special needs.
If I understand the bill correctly, there is going to be a carve-out
in the Medicaid system so that these complex cases will be, at least
for a period of time, reimbursed. Where are they going to get care?
Right now they are getting care, in many cases, in a school-based
health clinic that is going to be closed under the Republican bill that
is out here because it is not qualified to receive reimbursement. The
expansion of our qualified health centers under the Affordable Care Act
is going to be in deep jeopardy. I met with the CEOs of our qualified
health centers where we have expanded to deal with pediatric care,
dental care, and mental health. That is in jeopardy of being contracted
if you don't have the reimbursements from the people who live in that
community that we have under the Medicaid expansion. That is in
jeopardy. So don't believe you are protecting any vulnerable population
when you don't provide the structure in which you can have reasonable
reimbursements so that doctors, hospitals, and clinics can locate in
communities and be treated fairly under our reimbursement structure.
I am deeply disappointed. I am deeply disappointed with what we have
done to this great institution on this, such an important subject. I am
deeply concerned, about the impact this is going to have on the people
of Maryland and our Nation, and I will join my colleagues in doing
everything I possibly can, during the limited opportunities we have
only on the floor of the Senate, not in our committees--to do
everything I can to protect the interests of the people of Maryland and
our Nation so healthcare can be a right and not a privilege.
With that, I yield the floor.
The PRESIDING OFFICER. The Senator from Washington.
Ms. CANTWELL. Madam President, I thank my colleague from Maryland for
articulating the issues in this discussion draft that has been released
this morning.
As I hear him talk about these complex kids, how the cap is going to
work, and when people are going to be affected, it reminds me of the
book, ``The Smartest Guys in the Room.'' Right? Basically, people cook
up schemes they think other people can't understand or the broader
public will not catch on to in the hopes they can pass something. That
is exactly what is going on here, a hoax and a scheme that is not cost-
effective for the American taxpayer and will literally cut people off
of access to healthcare, and literally, if the House bill was mean,
this is doubling down on mean.
So I thank my colleague from Maryland for articulating the complex
kids issue because these are concepts. If this is a discussion draft, I
would hope my colleagues would come to the floor and discuss it--
discuss the concepts that are in this bill and debate them, but that is
not what is happening. In fact, we know very little detail at this
point in time because people are assessing the information and trying
to read and assess in between the lines.
I can state what I know and have gleaned so far by the accounts, and
that this is a continuation on the war on Medicaid. I say that because
with regard to this war on Medicaid, we didn't know where the Senate
would go in their proposal. We know what the House decided to do. The
premise and structure of the House bill is to cut Medicaid by capping
it and continually driving down the amount of Federal obligation to
this program.
I will tell you, it is not even a smart idea. If you want to reform
and deliver
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better healthcare at a lower cost, there are many ways to do that and
save dollars and give better patient care, but that is not what the
House proposal is. It was a budget mechanism. I am not just saying
that. I am talking to my healthcare providers at home, I am talking to
university professors, people who know and understand healthcare and
have studied it for a long time. What the House did and now the Senate
is doubling down on is nothing but a budget mechanism to cut people off
of healthcare--as my colleague said, the most vulnerable of our
population.
It is a wrong-headed idea. It is not going to help us control costs.
Medicaid reduces bankruptcy rates, helps people stay employed, and
boosts our GDP. Why would we want a draconian idea like cutting
Medicaid as the centerpiece of a budget proposal by our colleagues on
the other side of the aisle? As people have said, because they want to
take that revenue and give it away in tax breaks for the wealthy. I
guarantee you that is not what we should be doing.
The access to Medicaid is so important. Our veterans access the
healthcare system through Medicaid. Many of them receive care through
the VA, but also they receive services through Medicaid. Veterans would
be impacted and would lose care. Our children who are seen at
hospitals, such as the Children's Hospital in Seattle, are Medicaid
populations, and they would not have the resources to get access to
care. Our institutions that are covering individuals at Medicaid rates
would take a hit.
All the Senate proposal does is basically move that cap, but it is a
steeper cap at a point in time that makes and exacerbates this problem
of cutting people off of access to care. So if the House bill is mean,
this is just doubling down on mean.
There is nothing about destructing this safety net that is so
important to Americans that goes hand-in-hand with the philosophy about
how to drive down costs to healthcare. If you think about it, if we
came out here and had a discussion with 100 U.S. Senators and said a
great way to drive down the cost of healthcare would be to cut people
off of healthcare, most people would say that is not a smart idea
because when people are cut off of healthcare, we know that
uncompensated care exacerbates healthcare needs, challenges other parts
of our system, and delivering care to them makes it more expensive.
When we have had discussions and roundtables about the proposal that
the House had put out, providers in my State told me point-blank,
covering the Medicaid population has helped drive down and control the
rate of insurance in the private markets. By saying we are going to cut
Medicaid at a more drastic rate, we are going to just send a signal to
the market that rates for the private insurers should go up.
I don't think that is what my constituents want. They want us to
innovate. They want us to drive quality care and managed care into
parts of the United States where it doesn't exist. They want us to take
care of our most vulnerable population, and they want to make sure we
are not delivering that off people who are going into the emergency
room 50 times in a year because they don't have insurance.
We know the Medicaid rate is critically important. Medicaid costs up
to one-quarter less than private insurance. It is a way to deliver
care. We know measures we put into the Affordable Care Act, such as
moving people off of nursing home care to community-based care, has
saved Medicaid dollars. More States should do it.
We know plans such as bundling up the individual market into larger
programs so they can have clout like others who work for a larger
employer has also driven down costs. So those are the things we should
be accelerating, not this notion that we move forward as a country by
cutting the most vulnerable off of healthcare.
I ask my colleagues to come out and discuss this concept, discuss
this idea, how it will affect the healthcare providers in their States.
I plan to do that with my State. I hope they will come out here and
tell us why it is a smart strategy to cut people off from Medicaid. I
know no State that has the money to make up for the Federal share of
Medicaid that is going to be doubled down in this bill.
I do not want to see a war on Medicaid. What I want to see is
innovation. What I want to see is that covering people with some level
of insurance basically helps save everybody on their insurance bills as
well. I hope my colleagues will take this discussion draft and be proud
to come out here and discuss it, but we have heard very little of that
thus far.
Let's look at the real numbers, and I guarantee that we will hear
from Governors, we will hear from States, we will hear from providers,
we will hear from businesses, and we will hear from people who do not
think this is a good idea.
Already there are comments from the National Association of Area
Agencies on Aging: ``This strategy will also put . . . Medicaid [and]
states [and consumers] on a fiscally precarious path.''
We have heard from other people that the Medicaid cap is up to twice
as bad for States, will cause problems, and also from children's
healthcare groups: ``Converting Medicaid into a per capita cap . . .
would dismantle critical protections . . . to care for all enrollees.''
These aren't just partisan comments. These are the facts. What my
colleagues don't realize is that by taking a huge chunk out of
Medicaid, you are taking a huge chunk out of the safety net so many
Americans depend on. It will not help us lower costs. It will
exacerbate an escalation of rates for everyone in the market.
I thank the Presiding Officer, and I yield the floor.
The PRESIDING OFFICER (Mr. Sasse). The majority leader.