[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

[[Page S3704]]

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

[[Page S3705]]

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

[[Page S3706]]

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.