[Congressional Record Volume 163, Number 107 (Thursday, June 22, 2017)]
[Senate]
[Pages S3709-S3712]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                         Healthcare Legislation

  Ms. WARREN. Mr. President, today we finally got a look at the 
monstrosity of a bill that the Republicans have been hiding behind 
closed doors for weeks. Yes, it is finally clear how the Republicans 
were spending their time, locked in those back rooms.
  Now we know the truth. Senate Republicans weren't making the House 
bill better--no, not one bit. Instead, they were sitting around a 
conference room table, dreaming up even meaner ways to kick dirt in the 
face of American people and take away their health insurance.
  Remember, the Senate Republicans worked for weeks on this new bill. 
They worked really, really hard on it. It is pretty clear now exactly 
who they were working for. This bill has one flashing neon sign after 
another telling us who the Republican Party cares about, and it is not 
American families.
  The Senate bill is crammed full with just as many tax cuts as the 
House bill--tax cuts for millionaires and billionaires, tax cuts for 
wealthy investors, and tax cuts for giant companies. All those tax cuts 
don't come cheap. They start to add up after a while.
  Senate Republicans had to make a choice--how to pay for all those 
juicy tax cuts for their rich buddies. I will tell you how: blood 
money.
  Senate Republicans wrung some extra dollars out of kicking people off 
the tax credits that help them afford health insurance. They raked in 
extra cash by letting States drop even more protections and benefits, 
like maternity care or prescription drug coverage or mental health 
treatment.
  Then they got to the real piggy bank, Medicaid, and here they just 
went wild. Senate Republicans went after Medicaid with even deeper cuts 
than the House version--the Medicaid expansion gone, ripped up, and 
flushed down the toilet. The rest of the Medicaid Program? For Senate 
Republicans, it wasn't enough that the House bill was going to toss 
grandparents out of nursing homes or slash funding for people with 
disabilities or pull the plug on healthcare for babies born too soon. 
Senate Republicans wanted to go bigger.
  The Republican bill claims to protect kids with disabilities by 
leaving them out of the calculations that decide how big the Medicaid 
cuts will be in each State. I don't know if the Republicans were 
expecting a round of applause for pitting kids with breathing tubes 
against vulnerable seniors or someone needing treatment for addiction, 
but I do know this so-called exemption will not do a thing to help 
these kids. The Republican cuts still slash hundreds of billions of 
dollars for Medicaid, leaving States with no choice--no choice but to 
cut services that kids with disabilities desperately need.
  Medicaid is the program in this country that provides health 
insurance to 1 in 5 Americans, to 30 million kids, to nearly 2 out of 
every 3 people in a nursing home. These cuts are blood money. People 
will die. Let's be very clear: Senate Republicans are paying for tax 
cuts for the wealthy with American lives.
  Think about what would happen if the Republican bill becomes law next 
week. Picture a woman in her eighties who lives at home. She is shaky 
on her feet. She needs help preparing her meals or taking a bath, but 
her only income is her Social Security check. Right now, Medicaid helps 
pay for home and community-based services so she can stay in her home, 
someone who comes by to help for a few hours a week. Because of that 
help, she gets to stay home, to live independently. The Republicans are 
determined to cut taxes for millionaires and billionaires, so their 
healthcare plan cuts Medicaid money that helps millions of seniors stay 
in their homes.
  Without these services, this elderly woman can't live alone. Where 
does she turn? The usual answer would be a nursing home. Wait. Medicaid 
pays for most nursing home care in this country. The Republicans are 
determined to cut taxes for millionaires and billionaires, so they have 
cut Medicaid funding so much that there is no help for this woman at 
home and no nursing home bed for her either.
  What does she do? She stays home without help. She can't climb the 
stairs anymore. Her world shrinks. Eventually, most likely, she falls 
and ends up in the hospital. The care is expensive, and she is 
miserable.
  Finally, let's say the hospital gets her back on her feet, but there 
is nowhere for her to go when she is discharged. She heads back home to 
wait for the next fall, maybe the one that will be fatal.
  In their determination to cut taxes for the rich, is this what 
Republicans have planned for frail seniors in our country? Wait until 
they are all used up and then leave them out at the curb for the next 
trash pickup?
  It isn't just seniors who will be hit hard. How about a premature 
baby born with lung defects? His parents both have full-time jobs, but 
no matter how hard they work, no matter how many hours they put in, 
they will never be able to pay for the millions of dollars in 
surgeries, equipment, medicine, and therapy that their child

[[Page S3710]]

needs. Right now, Medicaid makes sure that kids with complex medical 
needs have coverage for feeding tubes and medication and surgery and 
physical therapy.
  Senate Republicans were so determined to offer tax breaks for the 
rich that they have taken away this baby's Medicaid. What happens next? 
Maybe the parents try their best, but they can't pay. Maybe they try a 
Kickstarter campaign, but it is not going to bring in enough to cover 
the medical bills. They take out a second mortgage, and then they go 
bankrupt and lose their home.
  Is that the Republican plan for this family--go live in a homeless 
shelter with your little baby, whose only crime was to be born 14 weeks 
early?
  Senate Republicans can wave their hands and say that everyone will be 
fine, but it is time for the rest of us to take a long, hard look at 
exactly what would happen to the people who have to live with the 
Republicans' reckless cuts.
  Senate Republicans know exactly what they are doing with this 
healthcare bill. Their values are on full display. If they want to 
trade the health insurance of millions of Americans for tax cuts for 
the rich, they better be ready for a fight because now that this 
shameful bill is out in the open, that is exactly what they are going 
to get.
  I yield my time.
  The PRESIDING OFFICER. The Senator from Pennsylvania.
  Mr. CASEY. Mr. President, I ask unanimous consent to speak as in 
morning business.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. CASEY. Mr. President, I rise to discuss, for just a couple of 
minutes this afternoon, the issue of healthcare and, in particular, the 
legislation that was unveiled today, what is referred to as a 
``discussion draft.'' It is legislative text, but it is not the final 
word on this issue. So we have to begin in earnest to engage in debate 
because we are going to be very limited in the time that we have.
  I think the best way to describe this legislation can be very simple, 
actually, in terms of the impact on a lot of Americans. Unfortunately, 
I don't think this is really an effort to improve the healthcare 
system. I think it is a scheme. It is a scheme that sells out the 
middle class. It hurts seniors and children and devastates the 
protections and healthcare for individuals with disabilities over time, 
and all of that is done to finance tax breaks for the very rich. There 
are other ways, of course, to describe it, but I will focus mostly on 
Medicaid.
  As it relates to Medicaid, this isn't a repeal and replace, or repeal 
and improve, or repeal and reform. This is repeal and decimate when it 
comes to Medicaid. The cuts may be stretched out, but they are, in 
fact, deeper over time.
  So if you are one of the 1.1 million children in Pennsylvania who 
receives Medicaid or one of over 720,000 Pennsylvanians with a 
disability who benefits from Medicaid, your healthcare could be at 
risk. My test would be that if any of those individuals lose their 
Medicaid benefits, it is a bad bill. I would hope that would be the 
test for every Member of the Senate.
  The other adverse consequence of this legislation is that it will 
cripple efforts to battle the opioid addiction in our country. We just 
had a great consensus at the end of last year where both parties came 
together on two pieces of legislation--one that dealt directly with the 
opioid epidemic, the so-called CARA bill, or the Comprehensive 
Addiction and Recovery Act. Then later in the year, there was another 
bill that provided some additional funding. All of that would be 
compromised, undermined, or degraded, at least, if this legislation 
went through because the biggest payer--certainly, in the top two, in 
terms of our paying for opioid treatment and services--is, of course, 
the Medicaid Program.
  So what we have here before us is a bill that is a tax giveaway to 
the wealthiest. The top one-tenth of 1 percent would receive thousands 
and thousands, if not tens of thousands, of dollars. One estimate of 
the earlier version of the House bill said, if you were in the top one-
tenth of 1 percent, you would get $197,000 each. Those people don't 
need $197,000 from a tax break from a so-called healthcare bill. They 
would, I think, expect that we would take care of the people that need 
healthcare: Vulnerable children. Some 40 percent of the children in 
America get Medicaid. Almost half the births in the country are paid 
for by Medicaid. People with disabilities are disproportionately 
dependent upon Medicaid, and they should have a right to expect--and 
their families should have a right to expect--that, if you have a 
disability, you should get Medicaid today, tomorrow, years from now, 
decades from now, and as long as you need it. You should have that 
guarantee. This bill takes away that guarantee for those families with 
a loved one with a disability.
  One of the many stories that we get from back home are from parents. 
Many of them are writing because their child has a disability or 
multiple disabilities, and they are dependent upon Medicaid. Here is 
just one:

       My son, Anthony, was born at 25 weeks and he weighed one 
     tiny pound. We were overcome with medical bills which 
     Medicaid thankfully paid for us. Since his birth he has had 
     multiple health crisis, seizures, sleep disorders just to 
     name a few.
       Most recently, Anthony was diagnosed with Autism spectrum 
     disorder, Tourette's syndrome, severe obsessive compulsive 
     disorder and Dyspraxia. He has suffered the most physically 
     and mentally because of his Tourette's. It's severe and he is 
     frequently unable to attend school due to his ``tics.'' They 
     are painful and debilitating. They make him unable to eat, 
     breathe and see at their worst. Far from what is commonly 
     depicted in the movies and on TV.

  Then, this father goes on to say:

       Two years ago I was forced to quit my job of twenty years 
     as a therapist to stay at home and care for Anthony because 
     of the amount of doctors' appointments he has and the number 
     of days of school he misses every year. Luckily with medical 
     assistance--

  That is the Pennsylvania version of Medicaid--

     covering his services I am still able to do so. If we lost 
     coverage, we would not be able to provide the support he 
     needs. We are sure of that.
       I truly realize that unless you are actually living this 
     kind of life, it's easy to turn a blind eye. I can assure you 
     that my story is much like thousands of others that DEPEND--

  And he has that word ``depend'' in all capital letters--

     on funds from medical assistance to cover doctors, 
     medications, therapies and durable medical equipment that 
     children with disabilities require. Families of children with 
     disabilities are desperate to not lose those benefits.
       My son Anthony is currently attending school almost 
     regularly and functioning the best he has for a very long 
     time thanks to the services he received from medical 
     assistance.

  That is otherwise known as Medicaid.
  So that is the reality for a lot of families. Now, I can hear some 
folks in the Senate saying: Well, maybe Anthony will not be affected 
because the Medicaid provisions are going to be up to the States, and 
the States can handle that. We are just going to put a cap on the 
dollars, and we are going to wind down the Medicaid expansion that 
covered 11 million Americans at last count, and the States will handle 
it.

  So we are sending back these challenges and the disproportionate 
burden that States will have to bear to make sure that Anthony--who has 
all those challenges in his life--has the coverage of Medicaid. The 
Federal Government will just wash its hands of that responsibility.
  No, Medicaid is a guarantee now, based upon your eligibility. That 
guarantee should remain. We are a great country. We have the strongest 
economy and the strongest military in the world, and we have the 
Medicaid Program. We don't have to sacrifice those kids or sacrifice 
the healthcare for one child who depends on Medicaid. We don't have to 
sacrifice that child in order to have another part of our budget funded 
appropriately. That is an insult, and anyone who is going to choose to 
support legislation that would fund tax cuts for the wealthiest, while 
at the very same time and in the very same bill would result in others 
losing coverage--and I am not only talking about children with 
disabilities. I am talking about adults who have coverage--20 million 
people in the last couple of years. Any Member of the Senate who 
chooses tax cuts for the wealthy over those children and over those 
individuals, I think, should examine their conscience, to use an old 
expression, because this kind of policy

[[Page S3711]]

that results in the most vulnerable among us losing their healthcare 
coverage is obscene. There are a lot of other words we could use--words 
we can't use here--because that is the definition of an insult to our 
values and to our country.
  We are a better country than what we will become if this Chamber 
votes in favor of a bill that will decimate Medicaid, the way this bill 
will. I realize it might take a long time. I realize it might be 
another Presidency or many Congresses from now, but the deed will be 
done here that will lead to that kind of misery. We have no sense of 
the misery that will be imposed upon those families because we have 
never had this before.
  We had a program in place for 50 years, and it has helped a lot of 
kids with disabilities. It has helped a lot of families to be able to 
hold down a job while their child gets the benefit of Medicaid because 
of a disability. It has helped a lot of poor children rise up from 
poverty and overcome terrible poverty because when they were kids--when 
they were very, very young--they got early periodic screening diagnosis 
and testing--the kind of early intervention and good healthcare that 
children get on Medicaid.
  A lot of seniors get into nursing homes. A lot of middle-class 
seniors from middle-class families get into nursing homes solely 
because they get the benefit of Medicaid, in addition to Medicare.
  The last thing I would say is that I think Senators in this Chamber 
should think about the basic inequity when they have healthcare. 
Everyone here has healthcare. All the families here have healthcare. 
All of our loved ones who are dependent upon us have healthcare. Yet 
some will vote to take away healthcare from some, and, in the very same 
bill, vote for gross, obscene tax cuts for the wealthiest among us--
most of whom, I would bet, don't want those tax cuts. They would rather 
see us take care of the vulnerable.
  So it is a basic choice. This isn't complicated. This is a very 
simple choice. I hope that in the course of this debate, some will come 
forward with some courage, some guts, and some compassion and do the 
right thing and vote this bill down.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from New Hampshire.
  Mrs. SHAHEEN. Mr. President, last month, Republicans in the House of 
Representatives passed a healthcare bill. They call it the American 
Health Care Act. It has been widely described as cruel and poorly 
crafted. Last week, President Trump described it as ``mean.''
  The House bill, by design, would take health coverage away from tens 
of millions of Americans. It ends the guarantee of affordable coverage 
for people with preexisting conditions. It cuts Medicaid, which is the 
principal program for ensuring children, people with disabilities, and 
seniors in nursing homes. It cuts Medicaid by more than $800 billion, 
and to compound that cruelty, the same legislation gives an enormous 
tax cut--over $30 billion--to those at the top of the income scale.
  We just heard this morning some of what is in the Senate bill, the 
Senate version of the American Health Care Act. In fact, not only does 
it not do what President Trump claims the Senate was working on--it 
doesn't address the mean aspect of it--but it actually makes it worse. 
In a State like New Hampshire, it provides for even deeper cuts to our 
expanded Medicaid Program, a bipartisan program that provides for 
treatment for substance use disorders for people dealing with the 
heroin and opioid epidemic. It would tax older Americans more than 
younger Americans for their health insurance and defund Planned 
Parenthood. There are all kinds of reasons. It would eliminate the 
requirement that people with preexisting conditions are able to have 
healthcare coverage. And all of this was done in secret behind closed 
doors.

  My office has been deluged with messages from constituents who oppose 
the Republican leader's bill. This shows whom we have heard from in 
recent weeks. I have received more than 5,400 messages opposing the 
bill and 108 in support, so 5,461 are in opposition, and 108 are in 
support.
  I am sure my colleagues on the other side of the aisle must be 
receiving similar volumes of mail and phone calls from their 
constituents, and they are hearing what I am hearing from my 
constituents: that if we go forward with this legislation that the 
House passed and that the Senate is considering, we are going to have 
people lose their access to healthcare and many people will have to pay 
more.
  So I appeal to Republican leaders. I urge you to stop and reconsider 
what you are doing. I want you to listen to some of the people we have 
heard from in New Hampshire, everyday Americans whose lives would be 
devastated by this legislation.
  Several months ago, I asked people across the State of New Hampshire 
to tell me their stories about the Affordable Care Act, to tell me 
their concerns, to let me know how it has made a difference for them.
  Here we see one of the people I heard from. This is Deodonne 
Bhattarai and her son Bodhi. They live in Concord, NH. As you see, 
Bodhi is in a special chair. Deodonne writes:

       Our three-year-old son is a bright, curious, funny little 
     boy who also has Spinal Muscular Atrophy.

  That is a degenerative neuromuscular disease that causes his muscles 
to be very weak.

       Our insurance initially denied coverage for his wheelchair, 
     but because of the Affordable Care Act--

  The ban on discrimination against those with preexisting conditions--

     my son is now able to explore his world independently.

  She goes on to say:

       I have [read news reports about the Republican 
     legislation], and I fear for our ability to maintain not just 
     insurance coverage but the type of quality coverage my son's 
     life depends upon.

  Next we have a picture of the McCabe family. They are from Kingston, 
NH, and this is their story:

       Our daughter, Ellie, was born with a rare and serious heart 
     defect called Hypoplastic Left Heart Syndrome.

  You can see Ellie there. She looks like a healthy, inquisitive little 
girl, and she is looking healthy because she underwent her first 
surgery when she was just 3 days old.
  The McCabes go on to say:

       It terrifies us to think about what would have happened to 
     our family if Ellie hadn't been protected by the pre-existing 
     conditions protections in place thanks to the Affordable Care 
     Act. Without those protections, either we would be in serious 
     debt for the rest of our lives or Ellie would not have had 
     her life-saving surgeries.

  Next, this is Dr. Marie Ramas. She serves at the Lamprey Health Care 
Center in Nashua, NH. That is a clinic I recently visited. She wrote to 
me:

       I have a 24-year-old patient who was born with a congenital 
     condition that did not allow his leg bones to grow 
     completely. This patient was unable to afford proper care and 
     had been walking with an old prosthetic for the last 3 years.

  Imagine not being able to get your prosthetic replaced for 3 years.

       Thanks to expanded Medicaid and to the ACA protections for 
     those with pre-existing conditions, he's now getting quality 
     care and can afford a new prosthetic.

  So his life has been changed by the Affordable Care Act.
  I have also heard stories from scores of entrepreneurs and small 
business owners who have benefited from the Affordable Care Act.
  This is Steve Roll of Keene, NH, and he wrote:

       In late 2015, I left my job to start my own business. I've 
     built a profitable business and expect to hire employees 
     within a year or two. Before the ACA, I wouldn't have taken 
     the risk to start a business because I have a pre-existing 
     condition and I wouldn't have been able to get an individual 
     health insurance policy. If the ACA is repealed, I'm 
     concerned that I'll need to put my business on hold in order 
     to go back to a corporate job just to get the healthcare 
     benefits.

  Well, the healthcare legislation that has been produced by the 
Republican leadership in the Senate would take away the requirement 
that people with preexisting conditions have to have access to 
healthcare.
  We have another businessperson here, Dave Lucier. He is the owner of 
Claremont Spice & Dry Goods in western New Hampshire. Dave wrote this:

       Before the Affordable Care Act, insurance costs were more 
     than a third of my business expenses. Now they're less than 
     an eighth. The ACA made it possible for me to go out on my 
     own and realize my dream of starting a small business here in 
     Claremont.

  And his business is doing well.
  Many women have written to me about how the Affordable Care Act has

[[Page S3712]]

ended discrimination against them by the health insurance industry--
discrimination because of their gender. In particular, they are 
grateful that the Affordable Care Act includes maternity care and 
contraception among the law's essential health benefits.
  This is Maura Fay of Exeter, NH. I talked about her last night when I 
was talking about the impact of this Republican bill on women's health. 
Maura wrote:

       My husband and I are self-employed. Before the ACA, we were 
     paying rates that were simply unsustainable for a middle-
     class family like ours. When I was pregnant in 2013, we were 
     forced to pay a maternity rider of an additional $822 a 
     month. I'm worried about the rollbacks in regulations around 
     essential health benefits, especially since so many of them 
     impact women. Maternity coverage shouldn't come with an 
     additional $800 a month price tag.

  Here in Washington, some folks seem to think that repealing the 
Affordable Care Act is all about politics, that it is about winning 
this debate. But for ordinary people in New Hampshire--people like 
Maura, like the McCabe family, like all the people I have shown 
pictures of this afternoon--for ordinary people in New Hampshire and 
across America, repealing the Affordable Care Act isn't about politics. 
For so many of them, it is about life-and-death. It is about the kind 
of lives they are going to lead. It is about whether they are going to 
be able to continue to afford healthcare, whether they are going to 
continue to pay their mortgage and buy prescription drugs. We need to 
listen to these ordinary people in each of our States whose lives and 
financial situations will be turned upside down if the Affordable Care 
Act is repealed.
  This process has really not been in keeping with our democratic 
process in America. For the Republican leadership here in the Senate 
and before that in the House to pursue a partisan approach to 
healthcare, to deny Democrats and even deny many of my Republican 
colleagues the ability to engage in the writing of this bill--it is 
deeply misguided to deny the public access, to deny a hearing on this 
bill, legislation that we know is going to hurt tens of millions of 
Americans.
  There really is a better way forward for both the Senate and for our 
country. If we put ideology and partisanship aside, if we work 
together, we can strengthen the parts of the Affordable Care Act that 
aren't working. We can continue Medicaid expansion so it can help 
people with substance use disorders, so it can help kids with 
disabilities, so it can help elderly people in nursing homes. We can 
fix what is not working, and we can improve on this law and make it 
better, but we can't do that if we continue to be divided up on our 
partisan sides, if we are not willing to talk about the issue, not 
willing to work together.
  The American people want us to work together here in Washington to 
address their concerns. Well, it is time to respect their wishes. Let's 
strengthen the Affordable Care Act so that it works even better for all 
Americans.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Wyoming.