[Congressional Record Volume 163, Number 107 (Thursday, June 22, 2017)]
[Senate]
[Pages S3715-S3725]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                         Healthcare Legislation

  Mr. BLUMENTAL. Mr. President, I am here to share the words, the 
stories, the fears, and some of the faces of people in Connecticut who 
will be impacted by the bill that was released this morning--the so-
called discussion draft, if that is the right term for it. We learned 
this morning, I think, why that discussion draft has been shrouded in 
secrecy. The reason is very simply that my Republican colleagues are 
ashamed and embarrassed about it, and rightly, because it is not only 
mean, as the House bill was, but it is meaner. It is cruel and costly.
  It will be cruel and costly to the people of Connecticut, in human 
suffering and illness and disease, and it will be costly in failing to 
prevent and treat disease before it becomes more expensive. That is one 
of the lessons of public health policy today: Treat earlier; prevent 
before diseases or illnesses or conditions become even more costly. It 
is not only a way to save lives; it is a way to save money.
  The voices and faces of Connecticut have been heard nowhere in this 
process because of its secrecy, because it has denied anyone in 
America, in fact, the opportunity to be heard, to comment, to make 
their views known. Speed and secrecy have been the watchwords, and they 
are a toxic recipe, and they should mean this discussion draft is dead 
on delivery today.
  My constituents have actually come in overwhelming numbers to an 
emergency field hearing on healthcare that I began in Hartford earlier 
this week, Monday morning at 9 a.m. They came for 2 hours. There were 
many more than we expected on very short notice, and they were there to 
make sure their voices and faces were heard and seen. That is what I 
did earlier in the week when I entered their testimony into the Record 
of the Senate. I was proud to do so.
  We are continuing that emergency field hearing, in fact, tomorrow at 
1:30 in New Haven at the Aldermanic Chambers, which have even greater 
capacity. We are expecting many more, judging by the response to the 
email blast and invitations that we have sent, because people care 
about healthcare.
  They should care because it is the difference between life and death, 
and this bill will be the difference between life and death for so many 
people in Connecticut. It will be death. Even though that statement may 
sound like hyperbole or exaggeration, the public health experts, the 
docs, and the hospitals that deliver healthcare in Connecticut and 
around the country know that it is true, and so do the people of 
Connecticut and our country.

[[Page S3716]]

  My colleagues have failed to hear those faces and voices because they 
have refused to have hearings, markups, committee meetings, and robust 
full debate on the floor of this Chamber, as is the practice and should 
be in other pieces of legislation. Why is it not for one of historic 
and unprecedented importance for the future of our Nation?
  Instead, they have met behind closed doors, a group of men who, 
maybe, coincidently, produced a bill that defunds Planned Parenthood 
and, in effect, furthers a war on women's health--an assault on women's 
healthcare that will deny mammograms, screenings, preventive care--and 
on primary care for men, as well as women, in this country.
  It will gut Medicare and Medicaid. It will rob millions of people of 
the healthcare they now have through Medicaid. It will mean higher 
costs and less care for America and especially for our seniors, who 
will be among the most victimized by these cuts.
  For anyone who cares about opioid addiction and abuse--and everyone 
in this Chamber, by an overwhelming majority, during the last session 
voted for the 21st Century Cures Act and then for the Comprehensive 
Addiction and Recovery Act, bipartisan, but it was nowhere nearly 
enough funded--this bill means, in fact, less funding than the House 
measure would have provided, from $65 billion increased funding for 
opioid addiction and abuse treatment to $2 billion.
  When my colleagues characterize this bill as heartless, they 
underestimate its impact on people who suffer from the disease--it is a 
disease, not a moral failing--of addiction and abuse.
  Yesterday the voices and faces that I elicited on the floor of the 
Senate were three people who have struggled with substance use disorder 
and encountered different endings--Justice, Sean, and Frank. We lost 
Sean just a few weeks ago. Frank could not come to the hearing we 
conducted on Monday because he is recovering, as well, and the 
heartbreak of Sean's loss so affected him.
  But Maria Skinner described their struggle to recover from that 
substance use disorder. Justice will likely never recover from the 
injuries she sustained when she overdosed. Although Frank is doing 
well, I am pleased to say he has access to Medicaid and the essential 
treatment services that he needs only because Medicaid exists in the 
present form. Denying him that kind of service and treatment means that 
he may be consigned to the risk that doomed Justice and Sean. The 
coldheartedness of the House bill was hard to match, but on Medicaid 
the Senate version has outdone even that coldheartedness--cutting the 
program even more drastically and costing our Nation, not just 
healthcare but also jobs.
  When we say Medicaid, let's be very clear whom we are talking about, 
and let me introduce three of the people who are affected.
  With me in this photograph are Evan, Amelie, and Amanda. They live 
with their mom in Ansonia, CT. Following their father's death 6 years 
ago, the entire family went on Medicaid so they could continue 
receiving the coverage they need and deserve and the healthcare they 
need and deserve.
  Their mom reached out to my office to speak at the hearing that I am 
having tomorrow. She wrote to me:

       I am very frightened that federal funding for state 
     Medicaid programs will receive tremendous cuts with this 
     potential repeal. I hope to advocate to all those in 
     positions of power that will listen so they can see a face to 
     this problem.

  The face to this problem is before us in this Chamber. It is children 
and families that will see Medicaid decimated for them if the 
Affordable Care Act is repealed, as would be done by this so-called 
discussion draft from our Republican colleagues.
  Today Evan, Amelie, and Amanda's mom is just learning how tremendous 
these cuts will be, and today she will fear even more for her 
children's health and well-being, because when we talk about cuts to 
Medicaid, we aren't talking about a line item on a budget. We aren't 
talking about a simple number or a statistic. We are talking about 
literally millions of children like Evan, Amelie, and Amanda, who have 
parents fearing what will happen if their reliance on Medicaid is 
betrayed ruthlessly, senselessly, and recklessly and if their 
dependence on this vital program for the basic healthcare they need is 
stripped away.
  This bill would also jeopardize affordable access to people with 
preexisting conditions. At my hearing, a woman named Michelle Virshup 
told her story of how the Affordable Care Act was there for her to 
provide coverage as well as services when she was diagnosed with an 
autoimmune disease in her early twenties. Now, 3 years later, she is 
doing a lot better and is actually an attorney fighting to remove 
barriers to healthcare for others in her community. She will suffer 
under this bill because her access to essential services will be 
weakened. She will be stripped of coverage that is actually affordable. 
She will be effectively cut from healthcare once and for all.
  When telling me about her illness, Michelle said:

       The Affordable Care Act allowed me to see it through and 
     the Affordable Care Act protects me now. Though my health is 
     good, my experience is a preexisting condition that will 
     follow me for the rest of my life.

  That is the thing about a preexisting condition. It follows people 
for the rest of their lives. It is preexisting before they have 
insurance coverage, and so it is preexisting forever. This bill, in 
enabling States to eviscerate the safeguards against abuse of 
preexisting conditions, means their healthcare will be in jeopardy and 
their lives will be at risk and the abuses that I fought when I was 
attorney general--time after time, year after year--will come back 
again.
  Among the most meaningful of the work I did as attorney general was 
to fight person by person when insurance companies said: No, we will 
not cover that preexisting condition. Their excuse proved to be a ruse, 
a charade, because they could abuse preexisting conditions, and they 
will do it again if this bill passes.
  This bill's depravity unfortunately goes even further. It actually 
defunds Planned Parenthood, our Nation's largest women's healthcare 
provider, while eviscerating protections that guarantee women have 
access to maternal care throughout their pregnancy. It not only stops 
and undermines effective family planning, but it then denies effective 
healthcare when women become pregnant. So it is a kind of catch-22.
  This action is cruelly ironic, turning women away from basic birth 
control services and then threatening their access to maternity care 
when they unavoidably become pregnant. It is really and simply 
devastatingly bad public policy, a foolish proposal that attacks 
women's healthcare and defunds Planned Parenthood, which is an 
overwhelmingly popular healthcare provider. The objective is to score 
cheap political points on the far right.

  Tomorrow in Connecticut, when I hold another hearing--and we may have 
another afterward--many of my colleagues may wonder why. They may well 
be scared of having that kind of hearing, where they have to listen to 
the voices and see the faces of the people who will suffer under this 
bill. They certainly have been too scared to have that kind of hearing 
in the U.S. Senate.
  I will hear from the people this bill will hurt. I will hear from 
people whose lives will be put at risk as a result of this heartless, 
cruel, and costly measure. I will be inspired by these people, and I 
will fight as long and as hard as possible to be sure that this bill 
never becomes law.
  Listening to our constituents is really the way democracy is supposed 
to work. We are proud of talking about democracy. We are approaching 
the Fourth of July. What better way to celebrate our democracy than to 
listen in this Chamber, in these halls, to the people who have 
expertise and experience that we need instead of the secrecy and speed 
that we are seeing now.
  I am proud that we are having these hearings in Connecticut. I urge 
my colleagues to do the same. They are emergency hearings because we 
face the historic and unprecedented exigencies of a proposed bill that 
will rip away guarantees of effective insurance coverage that Americans 
need and deserve.
  Healthcare is a right. Eventually we will have single-payer in this 
country. But for now, let's build on the Affordable Care Act, let's 
make it better, let's cure its defects, and let's work together across 
the aisle. We can do that if we have that resolve.

[[Page S3717]]

  Thank you. I yield the floor.
  The PRESIDING OFFICER. The Senator from Minnesota.
  Ms. KLOBUCHAR. Mr. President, I rise today to join my colleagues to 
speak out and ask for a normal process, for hearings, and for debates.
  The Presiding Officer and I have talked about this issue. I know the 
Presiding Officer has many good ideas to contribute, and I am hopeful 
that we can start over with a bill that would consist of a number of 
changes in our existing healthcare system. That is what I think we need 
to do, instead of this repeal bill that came to us without hearings. It 
is just not the right way to do this.
  I have already gotten reactions from my State. Just to use some 
quotes from an article in the Minneapolis StarTribune that was just 
posted--we have our health plans saying that what matters is Medicaid, 
and they are the leaders in our healthcare community, calling this bill 
disappointing because of the continued insistence on significantly 
cutting Medicaid, the federally paid health insurance program for those 
who are the most vulnerable.
  They have said things--the big story has been, What is it going to do 
to Medicaid? But, in fact, what our experts in our State are saying--
our health plans--is that this is really more of the same from what we 
have seen in the House bill, but over a different time period. There is 
an argument that in the end, it involves even deeper cuts.
  The Minnesota Hospital Association came out and has already, in just 
the last few hours, said that the last of the guaranteed benefits 
discourages preventive care and that this proposal ``creates a lot of 
chaos.''
  One of the heads of one of our major hospitals said:

       They are shortening up the money. But they're not giving us 
     the ability to manage the care.

  I have long advocated for changes to the Affordable Care Act--
significant changes. I think seniors should be given the ability to 
harness their marketing power and negotiate for lower prices under 
Medicare for prescription drugs. They are currently prohibited from 
doing that. I think that is wrong. I said that when the Affordable Care 
Act passed.
  I think there are many good things we could do to help with the 
exchanges and with small business rates, including doing something 
federally on reinsurance. My State legislature, which is a Republican 
State legislature, joined with our Democratic Governor and worked out 
an agreement on insurance. We are currently awaiting word from the 
administration on a waiver, but we think that is a good idea, and there 
are things we can do to bring that out nationally. I don't see that 
happening with this bill.
  In the end, what matters to me is how this bill affects individual 
people in my State. Laura from North St. Paul wrote to me about her 
concerns about the very similar House bill. Laura recently retired, but 
she will not be eligible for Medicare until next year. She has a 
daughter with several chronic health conditions. She is concerned that 
if these proposals get passed, she will end up paying far more for her 
health insurance, and her daughter might lose her coverage altogether.
  Take Mike from Grand Marais--that is in the far corner of Minnesota, 
right up at the tip. He has been self-employed his whole life and is 
now approaching retirement. He told me that just as he is about to 
retire, he will not be able to afford health insurance because of the 
way this proposal works. Like the House bill, it would increase 
premiums for older Minnesotans.
  A woman from Andover, MN, wrote to me that she is worried about this 
slam dunk attempt to check off a box on a to-do list, when, in fact, 
she is squarely in the middle of that box. She asked me to put a face 
on the type of person who is affected by rushing through this 
checklist, and that would be her 28-year-old son. She said that 
Medicaid coverage has been a lifesaver for her son because it helps him 
afford the treatment he needs to strive for an independent, productive 
life.
  I have heard from so many people from all of the corners of my State, 
from the old, the young, the middle-aged. I have heard from many people 
from the rural parts of my State about the House bill, which, of 
course, is very similar to the Senate bill that has been proposed here. 
They were especially worried about the billions in cuts to Medicaid, 
which is the lead part of the concern from the Minnesota Council of 
Health Plans.
  The Senate proposal, as I mentioned, would make even deeper cuts over 
the long term to Medicaid. Medicaid covers more than 1.2 million 
Minnesotans, including more than one-fifth of the people in the rural 
part of our State--20 percent of our rural population. This funding is 
vital to the ability of our rural hospitals and healthcare providers in 
those parts of our State to stay open and serve their patients. Many 
people who work in rural hospitals and who are served by rural 
hospitals have deep concerns.

  Even after seeing the Senate proposal for just these few hours, it is 
clear that this healthcare legislation would have massive life-changing 
implications for families all over the country.
  We know the President of the United States is not known for mincing 
words, but we also know he used very direct language when he talked 
about the House bill. The reports are that he called it mean, and there 
has been no denial that he said that. He didn't need a poll or focus 
group. He didn't need to know every detail of the bill. But when you 
hear that millions and millions of people could lose their health 
insurance, the wealthiest would get tax cuts, and then the people who 
need help the most would be forced to pay more, you can see why that 
would be a good word to describe a bill like this--``mean.'' What we 
don't want to have come out of the Senate is the ``son of mean'' or 
``mean 2.''
  Most of us agree that we must make changes to the Affordable Care 
Act, as I said at the beginning of my remarks. I would love to see 
those changes to prescription drug prices, not only with the Medicare 
negotiation I just mentioned, getting rid of that prohibition that 
stops 41 million seniors from negotiating for lower prices for 
prescription drugs by passing the bill that I have led for years to 
allow for that negotiation, but I would like to see more competition in 
two other ways. One is bringing in safe drugs from other countries like 
Canada. Senator McCain and I have a bill that would allow that to 
happen.
  The second is allowing for more generic competition and making it 
easier to have generic competition--again, not in the House or the 
Senate bill. Senator Grassley and I have a bill that would stop ``pay 
for delay.'' That is where companies pay generics to keep their 
products off the market. The nonpartisan Congressional Budget Office 
has assessed that we would not only save billions of dollars for the 
government but also for taxpayers if this passed. I would like to have 
that bill come up for a vote, maybe in the form of an amendment, 
because I believe it would pass.
  We could make improvements in the exchanges with the idea of 
reinsurance. There are many ways we could come together to make 
sensible changes to the Affordable Care Act. We can never have a bill 
that big without making some changes, and I think the time has come.
  Instead, we see a bill that was drafted behind closed doors. Yes, 
Democratic Senators were not a part of that; that is it the way it is. 
But I don't think those doors should be closed to the American people.
  Last week I attended the men's baseball game between Democrats and 
Republicans. It was an amazing event with over 25,000 people. At the 
end, when the Democratic team won, they took their trophy and gave it 
to the Republican team, and they asked them to put it in Representative 
Scalise's office. We should take the spirit that we saw at that 
congressional baseball game. We should take that spirit, and we should 
bring it into this Chamber, and we should start working on a bill 
together--not this bill. We should start working on a bill that makes 
some major changes to the Affordable Care Act. We have ideas on both 
sides, and that is what I think we should do.
  With that, I yield the floor.
  The PRESIDING OFFICER. The majority whip.
  Mr. CORNYN. Mr. President, I enjoyed listening to the comments of my 
friend, the Senator from Minnesota, and I would just say a couple of 
things.

[[Page S3718]]

One is that if 10 or so Democrats would have the courage to work with 
us, we could pass a true bipartisan healthcare bill, but the message we 
received from Democratic Leader Schumer and others is that they don't 
want to get involved in the process. So it is a little hard to take 
seriously the statement that if we would just be willing to work with 
them, we could get this done, because we have asked, and they have 
refused.
  But it is not too late. If we could get a bipartisan group of 
Senators to actually improve the status quo, which is a disaster under 
ObamaCare, then I think we could make progress. But that is not what I 
hear.
  I hear Senators criticizing the House bill. I guess that is because 
they haven't read the Senate bill, and we have said all along that we 
want to improve on what the House did. I think the draft bill, which is 
just that--it is a draft; it is a work in progress--does represent in 
many instances an improvement over the House bill.
  I look forward to working with a coalition of the willing, whoever 
that might be. I hear some happy talk, but I don't see many people 
willing to cross over and actually work with us, roll up their sleeves, 
and do the hard work to actually pass a bipartisan bill.
  I just have to say, I hear the criticism about cutting Medicaid. 
Well, the fact is, under the draft bill that was filed today, the 
essential safety net for low-income Americans is preserved. We actually 
will end up spending more money next year than this year and more money 
the following year because what we do is add a consumer price index 
increase.
  As the Presiding Officer knows, being a practicing physician, this is 
a complex issue, but the fact is, it is absolutely critical to 
reforming Medicaid and making it work better. In addition to spending 
more money each year, which is not a cut in most of America--maybe it 
is in Washington, DC--as we all know, Medicaid is an open-ended 
entitlement, so if you qualify based on your income, then you get 
access to Medicaid. Medicaid continues to drive the budgets--not only 
the Federal Government but also the State government--and crowd out 
other priorities that are also important, such as law enforcement and 
education.
  What we have decided we must do is to put Medicaid on a sustainable 
path by spending more money each year on low-income Americans. We still 
have some more work to do. But the idea that just because--compared to 
an uncapped entitlement with no limits on spending--we end up spending 
a set amount, as we spent this year or will spend next year and add 
more each year based on the cost-of-living index, that somehow is a 
cut, is just ludicrous. That is certainly not my understanding of what 
a cut is; it is a reduction in the rate of growth. So if you call that 
a cut, that assumes we are going to spend all of that uncapped amount 
of money, and we can't sustain the program if we do that.

  This is one of the three major entitlement programs--Medicaid, 
Medicare, and Social Security. I think it is our obligation, our duty, 
as we are saving the millions of people who are being hurt by the 
status quo and ObamaCare, to act responsibly to make sure this safety 
net program is available for low-income people going forward. We all 
should agree on that--that it is important and that we ought to put it 
on a sustainable, responsible fiscal path.
  So this was kind of an interesting experience here this morning. We 
roll out the discussion draft of the ObamaCare repeal-and-replace bill, 
we put it on the internet, we make sure everybody has access to it, and 
we ask for their input, their advice, and their suggestions, and we are 
starting to get suggestions. We welcome suggestions that people have to 
this initial discussion draft. But you have to start somewhere, and 
this is where we are going to start. Then we will have a process next 
week whereby any Senator who has an amendment to the bill has an 
absolute right to file that amendment and get a vote on it. I can't 
imagine a more transparent and open process than putting it on the 
internet, inviting people to comment and discuss, and then having an 
open amendment process following debate and then vote. That is what we 
are supposed to do--vote.
  So I think today represents a big step forward in saving those 
Americans who are being punished by health insurance choices that limit 
their right to choose a product at a price they can afford that suits 
their family's needs.
  We know what the promises were, and I guess I just have to repeat 
them again. President Obama said: If you like your policy, you can keep 
your policy. If you like your doctor, you can keep your doctor. An 
average family of four will see a $2,500 decrease in their insurance 
premiums.
  What we have seen is a $3,000 increase in insurance premiums for the 
average family of four--not a decrease of $2,500, an increase of 
$3,000. And people who buy their health coverage on the insurance 
exchanges in the individual market have experienced a 105-percent 
increase in their premiums. Now, I don't know about you, but there are 
not many things that come out of my paycheck on which I can sustain 
over a period of just a few years an increase like that of 105 percent. 
Imagine if you had a 105-percent increase in your rent payments for 
your apartment or your mortgage payments for your house or your car 
payments or anything else. That is harmful and damaging to hard-working 
Americans, and it really is a breach of faith with them, when they were 
told when ObamaCare passed that they would actually save $2,500.
  This discussion draft that was released today and put on the internet 
and is available to anybody who wants access to it is a product of 
years of debate on this floor and discussions among not just 
Republicans but the entire Senate and our constituents as well. We made 
our ideas public, and we sought feedback.
  The Senate Finance Committee alone, on which the distinguished 
Presiding Officer and I serve, has had no fewer than 36 hearings on 
ObamaCare since 2011, ranging from the high cost of ObamaCare to 
transparency in the Medicaid system.
  Just this year, there have been dozens of meetings throughout our 
conference. We would love to include Democrats, but they have chosen 
not to participate. Since May 4 alone, 18 of our conference lunches 
have been entirely dedicated to healthcare. There is a practical reason 
for that too--because without Democrats participating in the process, 
we have 52 Republicans in order to get 51 votes to pass a bill. That 
means everybody is essential to a successful outcome in repealing and 
replacing ObamaCare.
  So no one has been excluded. Everybody's ideas have been solicited. 
That doesn't even count individual meetings we have had with Senators 
and constituents.
  Even after receiving this discussion draft, some of my colleagues 
across the aisle continue to refuse to enter into debate because they 
say it is not a final bill. Well, that is the point. We didn't present 
this as a fait accompli; we presented this as a place to start. And 
they don't even want to start. All they want to do is criticize. But 
they don't want to criticize an actual bill; they want to criticize the 
House bill, because they haven't even read the 142-page Senate bill. 
This is called a discussion draft for a reason: We are opening up a 
conversation and a discussion with the American people.
  But we know Senate Democrats have chosen not to help to clean up the 
mess left by ObamaCare. I don't really understand how they can turn a 
blind eye or a deaf ear to their constituents. I am confident, with all 
of the people who are writing and calling me in Texas, that they have 
to have people in their States who are calling them and saying: My 
premiums are skyrocketing. My deductible is so high that I effectively 
don't have access to insurance.
  By the way, the insurance companies are pulling out of my State as 
fast as they can because they are hemorrhaging money.
  I don't know why they are not motivated to work with us, but 
apparently that is the decision they have made.
  Unfortunately, I think it goes back to this: When President Obama 
visited Capitol Hill the last time, in January of 2017, he had one 
message to Senate Democrats; that is, don't work with Republicans on 
healthcare. The President of the United States said don't work with 
Republicans on healthcare. This flew in the face of three consecutive 
elections since ObamaCare had passed where the voters had clearly

[[Page S3719]]

demonstrated their dissatisfaction with how ObamaCare actually worked. 
That shouldn't have been a surprise to anybody.
  I remember being here on Christmas Eve 2009 when Democrats passed 
ObamaCare with only Democrat votes at 7:30 in the morning. No 
Republicans voted for the bill; only Democrats voted for the bill. 
Since that time, they have gone from 60 Democratic Senators down to 48. 
They went from the majority in the House to the minority in the House. 
They went from holding the White House to Republicans now holding the 
White House. To me, the message isn't all that confusing, nor is it 
subtle. It is clear to me that the American people have rejected the 
failed promises of ObamaCare and have, frankly, punished our Democratic 
colleagues for passing it in the way they did and as a result of the 
failure to keep the promises that were made when it was sold.
  I have heard these concerns from my constituents in Texas for the 
last 7 years. I have read their letters and their emails, sharing some 
of their stories here on the Senate floor.
  This law has been expensive--about $1 trillion in new taxes. People 
wonder why the economy hasn't grown during the Obama administration and 
since the great recession of 2008. One reason is because of the huge 
tax burden and because of the regulatory burdens it imposed on small 
businesses, which are the primary engine of job growth in the country, 
and ObamaCare has been part of the reason for that.
  To my mind, this discussion draft does five things.
  First, our legislation zeroes in on the unstable individual market.
  Under ObamaCare, insurance markets across the country have languished 
under high costs and taxes, and the result has been that 70 percent of 
counties nationwide have fewer than two insurers to choose from. Less 
competition means higher prices because companies don't have to compete 
for the sale of a policy. In my State, one-third of Texas counties have 
only one insurance option. That is not exactly a choice; that is a 
monopoly.
  Our legislation will help the collapsing insurance markets that have 
left millions of people with no options by creating a stabilization 
fund that will balance premium costs and address the lack of coverage 
that so many across the country have been experiencing.
  I don't care what our critics say, we are not pulling the rug out 
from anyone. We will continue Federal assistance for healthcare markets 
through 2021 to make the transition smooth, much unlike our experience 
with ObamaCare. Ultimately, if we want to encourage a market to lower 
costs while providing better quality care, we have to get the 
government out of the way.
  The only thing I hear from our Senate Democrats is that they want 
more government involvement in your healthcare. That seems to be their 
default position. Well, we know from the failed experiment of ObamaCare 
that it doesn't work, at least insofar as the promises that were made 
when it was sold. So why would they default to a position of more 
government as opposed to more freedom to let you choose instead of 
government choosing for you and to punish you with a penalty if you 
don't buy the product that government orders you to buy?
  Our second goal is making healthcare coverage more affordable.
  Under ObamaCare, taxes and mandates cost the American economy $1 
trillion--I mentioned that a moment ago--which, as our constituents 
felt firsthand, was ultimately paid by patients through higher 
healthcare cost.
  Our friends across the aisle think we can raise taxes by $1 trillion 
and it won't have any impact on the consumer. Well, that is just 
ridiculous. We all know that those expenses get passed on to the 
consumer and that they get passed on in the form of higher healthcare 
costs. So when you tax prescriptions, for example, well, it is going to 
cost more. When you tax health insurance plans, which ObamaCare did, 
premiums are going to go up. And guess what. Taxing medical devices 
increases the cost of those devices and leads to job losses because 
they leave the United States, and they make those lifesaving medical 
products offshore in order to avoid the medical device taxes.
  These taxes and mandates have crippled our economy, and my colleagues 
on the other side of the aisle recognize that as well. That is why our 
healthcare plan will improve affordability by addressing ObamaCare's 
taxes, which have hurt American families directly by making their 
healthcare less affordable. This framework provides a long-term State 
innovation fund that encourages States to assist high-cost and low-
income individuals, making healthcare more affordable.
  We are also encouraging tax credits to help defray the cost of 
purchasing insurance, adjusted for age, geographical location, and 
income, so that those who need financial assistance get the help they 
need.
  Health savings accounts will also be expanded under our draft, giving 
Americans the choice of buying a hospitalization plan which covers 
major medical costs--not if they choose not to buy a comprehensive 
health insurance policy but, rather, to save money in a health savings 
account to be used for healthcare if they need it, and if they don't 
need it, they can use it for their savings. We give them that option, 
which they don't currently have under ObamaCare.
  The third principle is something our Democratic colleagues can 
certainly agree with us on, I assume, unless their reflexive action is 
to disagree with us on everything regardless of the facts, which 
sometimes seems to be the case, and that is, we should protect those 
with preexisting conditions. No American should worry about their 
ability to be covered when they move from job to job.
  Our draft legislation also allows children to stay on their parents' 
policies through age 26.
  There are no changes to healthcare for veterans, for Medicare, or 
changes to Social Security.
  Our fourth point of action is safeguarding Medicaid, which I 
addressed a little earlier, by giving States more flexibility. As we 
know, Medicaid is paid for by both a State and a Federal share, but the 
Federal Government sets the conditions by which that money can be spent 
on healthcare in the State as part of a low-income safety 
net. Bureaucrats in Washington, DC, shouldn't decide how Medicaid is 
applied in Texas. I don't know what rationale exists there. Why should 
the Federal Government tell a State how to spend its own money under 
Medicaid?

  I believe States know how to handle this best because they are 
closest to the problem and they can design healthcare programs that 
meet the needs of those States. I dare say, the healthcare needs in 
Texas are much different from States like Vermont, Idaho, or other 
States--smaller States, certainly, with a more homogenous population. 
We have a very diverse State. We have a large number of noncitizens in 
my State. So why not send the money to the States and give them the 
flexibility to design programs to deal with the needs of their people? 
That is why our draft allows States to choose between a block grant and 
a per capita support for the Medicaid population starting in 2020.
  We have done our dead-level best to make sure our draft doesn't leave 
anyone out, to ensure that the most vulnerable have protection--
including children with medically complex disabilities.
  Perhaps most importantly is the fundamental goal of this legislation 
to free the American family from ObamaCare mandates that have hit them 
where it hurts the most. We are giving Americans back their freedom of 
choice when it comes to healthcare, which has so long been denied them 
under the command-and-control regime of ObamaCare.
  Our healthcare plan empowers families to make their own choices. It 
repeals the individual mandate which punishes you if you don't buy the 
government-approved policy and the employer mandate that has resulted 
from people going from full-time work to part-time work because 
employers have sought to avoid that penalty. Finally, no longer will 
folks be forced to buy plans they don't need at a price they can't 
afford.
  I believe this is the framework for better care. But we are going to 
continue to discuss this plan and talk to anybody who is willing to 
talk to us

[[Page S3720]]

and work with us. If there is a way the bill can be strengthened, I am 
open to it. But the status quo isn't working, and our Democratic 
colleagues know it.
  This morning, I likened it as happening upon a terrible accident on 
the highway. We know people have been injured, and we have two choices: 
We can either stop and render aid--which is what we are trying to do 
for people hurt by the failures of ObamaCare--or you can drive right on 
by.
  Unfortunately, our Democratic colleagues have simply chosen to look 
the other way and drive on by. But before them is a real solution, one 
that has a chance to change the lives of millions of Americans for the 
better. So we hope they will reconsider and join us.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. KAINE. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. KAINE. Mr. President, I rise today to talk about the healthcare 
bill that is currently pending before us. Now that I have had a chance 
to look at it a little bit, I can see why there has been a lot of 
secrecy surrounding this process.
  Before talking about how I think this bill would hurt Virginians, let 
me talk about the process itself and how flawed I think it is. But the 
good news is that it is a process that can be fixed.
  This morning, when the bill was first described on the floor, I was 
interested when my friend the senior Senator from Texas, the majority 
whip, said we were doing it this way, through a budget reconciliation 
process, because Democrats didn't want to work together. I took offense 
at that comment.
  As the Presiding Officer knows, I am a member with him on the 
committee. I was just added to the committee in January. I have been in 
the Senate for 4 years. I have had great committees, but this is the 
committee I always wanted to be on because, as a former mayor and 
Governor, the two biggest line items in the budget I have had to deal 
with have been education and health. So, finally, I am on the committee 
I most want to be on.
  I believe this session of the Senate started on January 3. That was 
my first day on the committee. I have a letter I wrote on January 5. I 
had been a committee member for 2 days, and I wrote a letter to my 
chairman, whom I hold in the highest regard, Senator Alexander; the 
Senate majority leader, Senator McConnell; and the chairman of the 
Finance Committee, Senator Hatch, which has jurisdiction over Medicaid 
and Medicare issues. I wrote a letter on January 5, and I got 13 
Democrats, including me, to sign this letter.
  The gist of the letter is this: We would like to work with you. We 
would like to work with you to find solutions that would improve our 
healthcare system, whether that be within the Affordable Care Act or, 
more broadly, Medicare, Medicaid, and Medicare Part D. We want to work 
together.
  That was on January 5, 2 days after I had been added to the 
committee. As a member of the committee, I have been given no 
opportunity--not one--to work on this bill.
  The committee we serve on works productively. We work productively on 
pharmaceutical issues. We work productively on educational issues. In 
the committee the Presiding Officer and I serve on, we have passed 
legislation through our committee and sent it to the floor. Some of the 
legislation we have sent has already gone off the floor to the House. 
This is a committee that has a great bipartisan track record, and I am 
convinced that bipartisan track record is going to continue. But there 
has been one topic which has been taboo, and that has been to allow 
meaningful bipartisan discussion about this healthcare bill.
  When the House bill passed--now a number of weeks ago--it was our 
expectation that we would have hearings in the HELP Committee and in 
the Finance Committee about the bill. We haven't. The Democrats on the 
HELP Committee got a little riled up one day. We were having a hearing 
about something else, and a lot of us said: Wait a minute. We are not 
talking about the biggest topic in domestic politics in the country 
right now, which is this House health bill. We should be doing that in 
this committee. If we are not doing it in this committee, we are really 
not doing it.
  Why does it matter to have hearings in the committee? It is the 
committee hearing process where you put witnesses at a table and ask 
them questions. We would have patients, we would have hospitals, we 
would have doctors, we would have nurses, and we would have 
pharmaceutical companies and insurance companies, and we would ask 
them: What is good and what is bad about this bill? What is good and 
what is bad, and what needs to be fixed about healthcare in this 
country? That is what you do in hearings, but we haven't had one 
hearing, and the Finance Committee hasn't had one hearing either.
  We haven't had hearings in the committee on the House bill. We have 
had no willingness to hold hearings on the Senate substitute that was 
revealed today. The effort to draft the bill was closed-door. The 
notion that Democrats wouldn't participate--we weren't invited to the 
meetings. We didn't know where they were. We didn't know when they 
were. We had no chance to participate. Now we are being told that this 
bill described this morning--and we thought we were reading it online--
no, that is a discussion draft, not the bill itself. So I don't know 
whether the bill is going to be different, or is it the same? The 
notion is to rush it to the floor and then essentially to close off 
debate with a very meager amendment process.
  The Presiding Officer knows this, but I just want to explain for the 
public. By not having committee hearings where you can talk to 
witnesses and hear from the public and then discuss and propose 
amendments, this is what it will be on the floor: 20 hours of debate 
about the most important topic in anybody's life--their health. Twenty 
hours and then you finish the debate.
  Then, the majority leader indicates there is an unlimited amendment 
process, but the amendment process under budget reconciliation is as 
follows: An amendment will be considered, and there will be 1 minute of 
debate allowed for each side--1 minute.
  We are talking about healthcare. We are talking about life and death. 
I have a number of bills I filed that I want to offer as amendments, 
but for us to truly debate it and for the American public to truly 
understand it, 1 minute is ridiculous. But that is apparently going to 
be the rule for us next week.
  I think it is an outrage for a body that is known as the greatest 
deliberative body in the world to take up such an important topic and 
be told that it is in such a constrained way. So I just want to object 
to the characterization of the process this morning, that Democrats 
refuse to work together. I have evidence to the contrary. Within 48 
hours of being put on this committee, I asked for an opportunity to 
participate in this debate. I think I am entitled to respect as an 
elected Member of this body and a member of the HELP Committee to be 
engaged on matters dealing with healthcare. But thus far, I have not 
had this opportunity, and that is so out of character for the HELP 
Committee, I might add.
  I am going to be discussing this bill tomorrow with stakeholders in 
Richmond, where I live. Let me tell you what I see that really troubles 
me about the Senate bill. I think this bill hurts Virginians--
especially seniors, children, people with disabilities, and working 
families--and it hurts them all to deliver giant tax breaks, largely to 
the wealthiest Americans. It also shifts costs from the Federal budget 
to the States, and as a former Governor, that worries me.
  This bill would slash traditional Medicaid, which is a program that 
more than 1 million Virginians rely on. It is really important to point 
out that, when you are cutting Medicaid by potentially more than $1.3 
trillion over 10 years, that is what the House bill cut out in 
Medicaid--the House bill plus President Trump's proposed budget, $1.3 
trillion in cuts to Medicaid--and this bill could cut Medicaid even 
deeper by our reading of it.
  You have to ask yourself, you cut Medicaid by that much--who are 
Medicaid recipients? In Virginia, nearly 60

[[Page S3721]]

percent of Medicaid recipients are children. Kids who are in public 
schools receiving special education, many of their services are paid 
for by Medicaid. A youngster undergoing a cancer operation at 
Children's Hospital of King's Daughters in Norfolk, a lot of that is 
being paid for by Medicaid.
  A kid who has autism and is getting a couple of hours of autism-
related services to help them be successful in school is paid by 
Medicaid. A child in a dangerous household who might have to get 
institutionalized--not because the child is doing something wrong but 
because there aren't parents in the household who are helping the 
household stay together, they are in danger of being 
institutionalized--Medicaid can send services a few hours a week into 
the household to stabilize the family so the child doesn't have to be 
institutionalized, and that is being paid by Medicaid.
  When you cut Medicaid, that is whom you are affecting; 60 percent are 
children, 15 to 20 percent are people with disabilities. That is who is 
on Medicaid in Virginia; 10 to 15 percent are parents and grandparents 
in nursing homes and pregnant women. That is who is on Medicaid in 
Virginia.
  The Medicaid cuts in this bill are even steeper, even more 
significant than the cuts in the House bill. The bill would continue to 
allow something that I think is very challenging and that was a 
carryover from the House bill and may even be worse, which is the 
ability to charge older adults in the 55- to 64-year-old age range as 
much as five times higher than younger enrollees in the marketplace.
  When most people are in the 55- to 64-year-old range, they are not 
necessarily at the peak of their earnings. Their earnings are often 
starting to come down a little bit. If you let their rates rise that 
dramatically, you are really hurting people who can't easily go back 
and reenter the marketplace and the workforce at the same level they 
could have when they were younger.
  This is a bill that will hurt 22,000 Virginians who rely on Planned 
Parenthood for lifesaving healthcare. That is how many women in 
Virginia use Planned Parenthood as their primary doctor, as their 
primary physician--22,000, and this bill would hurt it.
  This bill would weaken health benefits by reducing the essential 
health benefits contained in the Affordable Care Act, and that affects 
pregnancy, that affects mental health, that affects opioid treatment 
programs, and it would force States to make very difficult budget 
choices.
  If you cut Medicaid by that much, you are going to make Governors and 
mayors decide: Wow. OK. Whom do I cut? Do I cut the kids? Do I cut the 
disabled? Do I cut the elderly? Do I cut all three or do I raise taxes? 
You are just pushing this off on the shoulders of States.
  There is good news. I want to finish with good news. I always try to 
finish or find some good news. There is good news. We can do this 
right. We don't have to do this wrong. It is actually really simple. 
When the Senate bill is truly ready, and it is not just a discussion 
draft but a real bill and it is put on the floor, all we have to do is 
refer the bill to the two committees--the Finance Committee and the 
HELP Committee.
  Let the committees hear from the public, from providers, patients, 
doctors and nurses, and hospitals. Let members of the committee--
Republicans and Democrats--ask questions. Let us propose amendments. 
Let us improve it.
  This doesn't have to be a complete up-or-down. Why can't we have a 
meaningful discussion and ask questions and propose amendments in a 
deliberative way and improve the bill? It is not as if the Democratic 
minority can just roll over you. We are the minority in this body, and 
we are the minority on both the HELP and Finance Committees. Unless I 
can put an amendment on the table and convince some Republicans it is a 
good idea, my amendment is going to be voted down. If I can't convince 
somebody around the table this is a good idea, I will take it, and my 
amendment will be voted down. At least, let's have a meaningful 
discussion about the most important expenditure anybody ever makes in 
their life and the largest sector of the American economy.
  What would be wrong, what could be wrong in letting the HELP 
Committee take a look at the healthcare bill? What would be wrong, what 
could be wrong with letting the Finance Committee take a look at a bill 
that affects Medicaid and Medicare, which is in their jurisdiction?
  What would be wrong, what could be wrong with allowing public 
witnesses to come to these committees and testify what they like and 
what they don't like? I may learn some things about the bill that I 
like after listening to some witnesses. What would be wrong, what could 
be wrong with allowing this to happen in this great deliberative body?
  I guarantee it would improve the outcome. It would improve the 
product. More minds looking at this and debating and in dialogue will 
improve it, if what we want is an improved healthcare system. Maybe 
that is not what we want. Maybe doing our best job is not what we want. 
Maybe what we want is the ability to put something through only with 
votes from one party and with the other party completely shut out of 
it.
  What I think we should want is to do the best job for the most people 
when it comes to the most important thing in their lives, their health.
  I will conclude and say that we can get this right. We can take 
advantage of the work product of the Republicans, who have been working 
on this draft by putting it in the HELP and Finance Committees and 
allowing the body to treat it as any other piece of legislation and 
improve it before we are forced to vote for it in a rush vote on the 
floor.
  With that, I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. SCHATZ. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. SCHATZ. Mr. President, there are two things Americans need to 
know about this Republican healthcare plan. The first is that it is 
going to make insurance more expensive, and the second is that it is 
going to make it harder to get healthcare in the first place. That is 
the bottom line of this bill: higher costs for less care--and all for a 
tax cut for the rich. That is what we are doing.
  We are taking about $800 billion worth of revenue, eviscerating it, 
eliminating it. Those tax revenues were basically tax increases passed 
under the Affordable Care Act. They were tax increases on the 
wealthiest among us. What we are doing is getting rid of all those tax 
increases in order to cut Medicaid. That is what this bill does. That 
is not what Americans had in mind when they said on a bipartisan basis, 
on a majority basis--when they asked Congress to fix healthcare. When 
you read the fine print, you see that it gets worse every moment, and 
you realize how bad this plan is.
  The Senate version did something extraordinary: It actually moved to 
the right. And that is a real legislative achievement. Look at 
Medicaid. This is a program that helps one out of every five Americans, 
two out of every five children in the United States. It helps one out 
of every two families who have a newborn baby. And it covers three out 
of every four long-term nursing home residents.
  This program literally saves lives--nursing home patients; people 
struggling with opioid addiction; people who are working two jobs but 
still don't make enough to cover their own healthcare insurance--but 
with this bill, Medicaid as we know it will be destroyed, all so that 
people at the top of the food chain can pay less in taxes.
  This bill actually has a certain symmetry to it. There are at least 
$800 billion worth of cuts to Medicaid--probably more but at least $800 
billion--and it just so happens that there are also around $800 billion 
worth of tax cuts for the wealthy. So insurance executives will be OK. 
Don't worry about them. What we should worry about is women who need 
Medicaid for maternal health services. We should worry about seniors 
and people with disabilities.
  Activists for disability rights are appropriately freaked out about 
this bill. People in wheelchairs protested outside of a Senate office 
earlier today,

[[Page S3722]]

and some of them said that they would literally die if this bill 
passes. It was an intense protest. And we hope everybody is OK, but it 
is intense because these are intense issues.
  These are personal issues. These are healthcare issues. People are 
worried--not about some abstract public policy or political debate; 
they are worried about their own lives. And they are not wrong. Because 
of Medicaid, people now have access to physical therapy and 
immunizations. They can see a counselor for mental health problems and 
opioid addiction. They can afford the medication they need instead of 
relying on free samples from clinics. Medicaid has changed everything 
for them.
  This is not just good for patients, it is also good for taxpayers. By 
giving preventive care, we save money. And if TrumpCare becomes law, 
those services will go away, thanks to $800 billion in cuts.
  This bill also lets insurance companies opt out of covering essential 
health benefits. I want to be very clear about this. This is a term of 
art. It is a piece of jargon. I am going to go slowly here and not 
assume that if you are not in politics, you would understand what an 
essential health benefit is.
  Basically, if you are getting a healthcare plan, there are 10 things 
that, under Federal law, a healthcare plan has to cover. It just makes 
sense. I will list them. They are ambulatory patient services; 
emergency services, so ER visits; hospitalization--if you have to stay 
overnight in the hospital, it has to be covered in your healthcare 
plan; maternity and newborn care; mental health and substance abuse 
services, including behavioral health treatment; prescription drugs; 
rehab; laboratory services; preventive wellness and wellness services; 
chronic disease management; and pediatric services.
  So I want you to imagine a world where you can get an insurance 
plan--a so-called insurance plan--but under the law, they can tell you: 
By the way, we don't cover hospitalization. By the way, we have this 
great insurance plan, but if you need any prescription drugs, those are 
out-of-pocket--not a copay; you have to pay all of it. By the way, we 
will give you an insurance plan, but if you have mental illness, you 
are on your own. By the way, if you get pregnant, we don't cover that.
  It is a healthcare plan, which is why we have a statute, a Federal 
law, that says ambulatory patient services, emergency services, 
hospitalization, maternity and newborn care, mental health and 
substance abuse services, prescription drugs, rehab, lab services, 
preventive and wellness services, and pediatric services have to be 
covered. Otherwise, it is not insurance. Every one of these benefits is 
covered full stop under the current law, but what the proposal does is 
it eviscerates essential health benefits.
  I don't know what the CBO is going to say, because they got rid of 
the individual mandate, and it is going to be unclear. There is a real 
possibility that there will actually be an increase in the number of 
people who are covered, but that coverage is going to be nonsense. Can 
you imagine having a health insurance plan that doesn't cover maternity 
care? Can you imagine--especially nowadays, when half the time when you 
go to the doctor, they give you a prescription--so you go to the 
doctor, and they say you need this, and you say OK, and then you have 
to pay out-of-pocket? What is the point of insurance if none of the 
things you need are covered by the insurance? That is what this bill 
does.
  I am also worried about the distractions in this bill. It defunds 
Planned Parenthood and doesn't provide nearly enough for opioid 
addiction programs. I want to be clear about what I mean by 
``distraction.'' It is my supposition--I don't know for sure that these 
things were intentionally either omitted from the bill or put in the 
bill to allow some of my Republican colleagues to get well 
legislatively. What do I mean by that? Opioid treatment was tens of 
billions of dollars in the House version. They brought it down to less 
than $1 billion. That puts somebody on this side of the aisle in a 
position to say: Even though I am for $800 billion of Medicaid cuts, 
which will eviscerate opioid treatment across the country, I am going 
to introduce an amendment and we are going to increase opioid 
treatment. Once we get a ``yes'' vote, well, you know, I was really 
concerned, but with my amendment, we have more money for opioid 
treatment.
  Don't fall for that trick. It is a trick. The way to fund opioid 
treatment is to fund opioid treatment. Medicaid is both the best way to 
do it clinically and the best way to do it fiscally. So I am afraid 
they intentionally left that out so somebody can go in and be the hero 
on the other side, while not actually solving the problem--likewise 
with Planned Parenthood. The way you fund opioid treatment is through 
Medicaid.
  We had 13 men working in secret without input from any women or 
Democrats or experts or advocates.
  Part of the thing about healthcare, as the President says, is nobody 
knew it was so complicated. But you really need hearings. You really 
need to understand how all of the parts of a system interact with each 
other. Let me give an example. You cut Medicaid, and somebody who is 
Medicaid-eligible but also a veteran--you don't know for sure whether, 
if Medicaid services are not available, they are going to go back into 
the VA system and cost the VA system more money. If you cut preventive 
treatment, you don't know if you are going to end up having to pay on 
the back end with more ER services. So the reason you have hearings is 
you have to have some rather technical expertise in the room to say: 
Hey, if you do this, this might happen. If do you that, this might 
happen. If you do this, we are not quite sure what might happen.
  But the idea that 13 men with very little expertise in healthcare 
policy--they are not unintelligent, they are not unqualified to be 
public policy makers, but the whole thing about being in the Senate is 
that, for the most part, we are supposed to be, as they say--Jack or 
Jane--Jack of all trades, master of none. We are supposed to be pretty 
good at receiving information, kind of distilling it, asking the right 
kinds of questions, listening to our constituents, and then 
crystallizing all of that into a bill.
  The problem with this process is they did about one-third of that. 
They talked to each other, and they talked to Republican lobbyists, but 
they didn't talk to the people back home. They didn't talk to people 
who run community health centers. They didn't talk to mental health 
advocates.
  We have people who come from Hawaii and across the country who 
advocate for every specific disease treatment and disease research. 
These people usually are touched personally by their issues. They come 
in, and most of us receive them and talk to them and think about how to 
get them more funding or more reimbursements through NIH or CDC or the 
Department of Defense or wherever we can find resources for them.
  That is the process of being in a legislative context if you are not 
personally an expert on healthcare policy. If you do it in the dark of 
night, if you do it literally without any women, if you do it literally 
without any people from the other party, you are going to get a bad 
product. They knew they were going to get a bad product, but they made 
a judgment. They made a judgment.
  They decided that the longer this bill sees the light of day, the 
lower the chances it has of passing, and I think they are right. I 
mean, if this thing is subjected to real sunshine, it will just wither. 
That is just a fact. This is why they didn't have any hearings in the 
House, this is why they are not only not having any hearings in the 
Senate, but they are going to allow for I think it is 20 hours of 
debate under this silly vote-arama procedure.
  What they will do is, I think, yield back a lot of their time. What 
does that mean? That means 20 hours will become 10 hours because they 
don't want to defend their bill.
  They are absolutely happy to trash the Affordable Care Act and say it 
has a series of problems and all the rest of it. You know what, the 
Affordable Care Act has a series of problems. No doubt about it. I will 
tell you it is way better than this. I will also tell you it is way 
better than the situation we had before the act was passed.
  The No. 1 cause of bankruptcy in the United States was getting sick. 
Think about that. Before this act, people

[[Page S3723]]

would not be just afraid for themselves when they got sick, when 
something catastrophic happened to them, either a chronic disease or 
something that imperiled their lives or an accident, but you would have 
dual anxieties, right? You wondered whether you were going to be OK, 
but you also wondered whether you were going to be able to make it 
financially.
  So we are sort of beyond that, and now we have a law that has been on 
the books that does need fixing. I know the Presiding Officer and the 
Senator from Missouri, who is waiting to speak, would be pleased--
really would be pleased to participate in a bipartisan process.
  I think about the chairman of the Health, Education, Labor, and 
Pensions Committee, one of the best statesmen in the U.S. Senate, Lamar 
Alexander, a Republican with whom I disagree on a lot, but he and Patty 
Murray did a bill on public education that got--I don't know--84 votes 
or something. Liberal Patty Murray and conservative Lamar Alexander did 
a deal. Orrin Hatch, President pro tempore of the Senate, is someone 
who worked with my predecessor, who worked with Teddy Kennedy, who did 
bills and did deals.
  So I understand we are kind of in this squabble about whether there 
is good faith or there was good faith. Our view of this is you went 
into the reconciliation process before even, in any serious way, 
pursuing bipartisan legislation. You decided you wanted 51 votes, not 
60 votes, and that was sort of poisonous fruit from the tree. Fine. 
That is our view. Your view is that you serially tried to reach out to 
us, and we have rebuffed your overtures. I have my view; the 
Republicans have their view.
  Right now, you are about to walk one-sixth of the American economy 
off a cliff, and you are also about to harm tens of millions of 
individuals in all of our home States--not Republicans or Democrats or 
Greens or Independents or Libertarians or people who don't vote or 
whoever it may be, but people are going to really be hurt by this bill. 
People are really going to be hurt by this bill.
  Forgetting the politics, I think we have an opportunity to avert the 
harm. If this bill does come crashing down, then I think we have an 
opportunity to work together on healthcare. I, for one, pledge that if 
we are in a position to sit down on a bipartisan basis and come up with 
improvements to the existing statute, I will be the first person to say 
yes to that kind of process. It is not too late. All we need are three 
Republicans to say: Let's slow down. Let's have a hearing. Let's work 
with Democrats. Let's do this the right way.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Missouri.
  Mr. BLUNT. Mr. President, since the current healthcare bill--the bill 
usually called ObamaCare--passed, every year Missouri families have had 
to worry about whether their healthcare plans would be canceled, 
whether their options and access would be taken away, whether they 
could have the same doctors next year that they have this year, whether 
they could go to the same hospital next year that they could go to this 
year, whether their premiums would be going up, but if they were 
worried about whether their premiums were going to be going up, that 
was a worry that everybody else in every State had because premiums 
went up everywhere.
  In fact, this situation has gotten so bad that in one-third of 
America's counties today, only one company in one-third of the counties 
today will even offer insurance. So the options are to buy from one 
company or to pay the penalty because your only choice is that one 
company. That one company gets to file a rate that the State regulator 
gets to agree to, if the one company is going to stay. In fact, I think 
this week the State of Iowa that has only one company providing 
individual insurance for the whole State, that one company said they 
would stay again next year, and then they filed an increase of over 40 
percent on those policies for next year.
  In Missouri, where I live, 25 counties will not have a provider next 
year, and it could be higher than that. One company has already said 
they will not be there next year. Twenty-five of the counties they sold 
policies in only had one company providing policies. We now know that 
at least 40 percent of all Missouri counties will not have--I mean, 40 
percent of all U.S. counties will not have anybody even willing to 
offer these plans. This is a significant problem, and it just didn't 
occur when this President was sworn in or this Congress took over.
  Premiums in your State, Mr. President, have gone up 123 percent since 
2013. In my State, in Missouri, they have gone up 145 percent; in 
Alabama, 223 percent; in Alaska, 203 percent; in Oklahoma, 201 percent 
since this plan went into effect, and that was just 2013. This is not 
30 years ago. This is 4 years ago.
  The average increase for American individuals and families for 
getting policies under ObamaCare is 105 percent. Now, remember, this 
was the plan that was supposed to ensure that your costs would go down 
per family at least $2,500. The ``at least $2,500 number'' was close to 
right, but what was close to right about it is that your plan probably 
increased at least $2,500 if you had that kind of plan. The status quo 
just simply will not work.
  The draft legislation, as it stands right now, preserves access to 
care for people with preexisting conditions, it strengthens the future 
of Medicaid, it does not change Medicare in any way, and it gives 
people more health insurance choices than they otherwise have as States 
exercise their options under the law. It allows people to stay on their 
family insurance until they are 26. That, along with preexisting 
condition coverage, is usually seen as the two most popular things in 
the law as it stands now. They would still be in the law.
  Now, Members of both parties--and the reason I say ``as it stands 
today'' is Members of both parties will have an opportunity to amend 
this bill. In fact, we will have a vote probably the night before we 
take the final vote on the bill, where every Member can make amendment 
after amendment after amendment on this bill. There will be plenty of 
chances to change this bill on a topic that the Members of the Senate 
probably know more about, and, by the way, because it is such a big 
Federal obligation and responsibility, should know more about than 
virtually anything else we deal with in a level of specificity that is 
higher than anything else we deal with.
  Believe me, anybody who wants to read that bill--and I will, you 
will, and others will, some will not--anybody who wants to read that 
bill will have plenty of time to read it and plenty of opportunity to 
amend it, but it will be amended, so we need to be sure we understand 
the final product might not be exactly what we have before us today.
  I am going to carefully look at the final legislation. I am going to 
carefully look at how this addresses problems of Missourians. I think 
one thing that is absolutely clear is that Missouri families need a 
more reliable and affordable healthcare system. This bill is an 
important first step in that direction. The status quo cannot continue 
to be the status quo.
  By the way, there were plenty of opportunities over the last 7 years 
to make the kind of incremental changes that all of our friends on the 
other side said they would love to make, and they were in charge.
  We had a bill over here that Senator Collins, I believe, was the 
principal sponsor of that said: Well, let's change that 30 hour 
requirement; that if you work 30 hours, you have to have insurance to 
40 hours. Now, that is not a very big change, but it is a very big 
change if you have a 28-hour-a-week job, and the reason that you have 
that 28-hour-a-week job is the law told your employer, if you hire 
somebody for 30 hours, you have to provide health insurance for that 
person.
  Now, the employers by the way--nobody is better in America today than 
employers to provide health insurance and there is no better place to 
get your health insurance than at work, but we have almost forgotten 
the tragedy of the workplace where because of ObamaCare so many people 
worked two part-time jobs because the law said you don't have to pay 
health insurance if they work less than 30 hours.
  Well, we tried to figure out a way to get more people to work at a 
full-time job, not a very big change. Our friends on the other side 
were in control for year after year after year after that

[[Page S3724]]

bill was introduced. Nobody stepped up and said: Let's do that. Let's 
make that change. Let's get more people in full-time jobs.
  These insurance markets were collapsing. I don't think there was any 
proposal on the other side to do anything about it. One of the 
difficulties we find ourselves in now is we are trying to save a 
critically important system--the American healthcare system--while that 
system is collapsing around us. That means it is not going to look as 
good as it would have looked if we could have gone back 7 years and 
done the things you and I wanted to do when we were House Members--
giving more people more chances to buy more policies, having more 
transparency, being sure, if you didn't pay taxes on insurance you got 
at work, you also didn't pay taxes on money you spent for insurance if 
you had to buy it as an individual. There were lots of things that 
could have been done that were proposed. We can still go back and do 
that. This is clearly a first step.
  The Secretary of Health and Human Services has over 1,400 places 
where that person's two predecessors defined what the law was supposed 
to mean. So earlier this week, Secretary Tom Price said he was going to 
look and his staff was going to look at every one of those 1,400-plus 
places and figure out if there is a way to define the law better so it 
doesn't have the impact on family economies or family access to 
healthcare that it currently has. That is an important step too.
  This first step matters as well. I say to the Presiding Officer, 
nobody has been a more vigorous advocate of this debate than you have. 
We have an opportunity to continue this debate over the next several 
days. I look forward to it, and it will be interesting to try to remove 
the fact from the fiction when we talk about all the things that 
supposedly could have happened up until now. The fact is, they didn't 
happen.
  I yield the floor.
  I suggest the absence of a quorum
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. UDALL. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Blunt). Without objection, it is so 
ordered.
  Mr. UDALL. Thank you, Mr. President, and thank you for the 
recognition.
  All across my home State of New Mexico, thousands of hard-working 
people owe their healthcare and in some cases their lives to the 
Affordable Care Act. Since early January, I have received over 10,000 
letters, emails, and calls from New Mexicans pleading with me to help 
save their access to healthcare. Over 96 percent of my constituents who 
have contacted me about healthcare oppose TrumpCare.
  Let me say that again because I think it is a very important number. 
Over 96 percent of New Mexicans who have contacted me about healthcare 
over the past 6 months are opposed to TrumpCare, and they are opposed 
to the effort to repeal the Affordable Care Act.
  The TrumpCare bill is a disgrace and a disaster. It is a disgrace 
that Senate Republicans are trying to force an extremely unpopular bill 
on the country in 1 week, and they are doing this even though this bill 
affects one-sixth of our economy and even though it would cost hundreds 
of thousands of people in New Mexico and millions of Americans to lose 
access to healthcare, prescription drugs, drug addiction counseling, 
and other lifesaving services.
  The Republican plan raids Medicaid, it strips away protections that 
prevent insurance companies from canceling your policy for getting 
sick, and it reduces the services your insurer has to provide. It does 
all this to pay for massive tax cuts for the wealthy.
  This bill is a disaster because it would be devastating for older New 
Mexicans, families who are struggling to make ends meet, women, people 
with preexisting conditions, and New Mexicans in rural areas.
  Our rural areas would be particularly hard hit. In some cases, it 
would do very severe damage to healthcare in rural areas. Hospital 
administrators in rural counties like Guadalupe County and Socorro 
County in my home State have told me that losing Medicaid 
reimbursements could break their budgets, and that could force the 
small, rural hospitals to limit services or even to close. You know, 
the last thing you want to have happen in a small, rural community is 
to have the hospital close. We all know what happens after that: The 
hospital closes, and then a diminution in services takes place, and it 
is very hard for communities to stay alive in that situation.
  It is no wonder the American people don't want this bill. They don't 
want TrumpCare.
  I suppose it is no surprise that the Republicans have kept it 
hidden--without letting anyone see it. I want to talk about that for a 
moment. That is not just a talking point for Democrats. If this bill 
passes and becomes law, many people will suffer, and it has been kept a 
total secret.
  I wish I could read on the Senate floor every story I have gotten 
from my constituents who are concerned. If I could, I could hold the 
record for the longest floor speech. I have shared several in the past, 
but today I would like to read just one, which is from Elena from 
Albuquerque.
  This is a picture of Elena from Albuquerque, NM. She has a very 
moving story that she wrote me about. In this story, I think you see 
the story of the Affordable Care Act and the good it does.
  Elena is 31 years old.
  Earlier this week, I told some of Elena's story in a speech on the 
Senate floor, but today I want to tell Elena's full story.
  Elena graduated last year from the University of New Mexico Law 
School--my alma mater--and she is quite determined and motivated, as 
you will hear. She wrote her story in a Facebook post to friends and 
gave me permission to share it with the American people and with my 
colleagues here in the Senate. Here is her story. This is Elena's story 
in Elena's words:

       For the past 18 months, I have been carrying around a big 
     secret. I felt really guilty for not sharing it, yet, try as 
     I might, I could not work up the nerve to tell you all. Lucky 
     for me, Senator Udall has helped me to rip off the Band-Aid.
       In the spring of 2016, I found out that I have a BRCA-1 
     mutation, which puts me at a very high risk of developing 
     breast and ovarian cancer. Women with a BRCA-1 mutation tend 
     to get breast and/or ovarian cancer very young, sometimes 
     even in their 20s or 30s.
       When you have a BRCA-1 mutation, you have two options: One, 
     you can get breast screenings every six months and yearly 
     ovarian screenings and keep your fingers crossed that nothing 
     pops up. Or two, you can get your breasts and ovaries removed 
     and significantly decrease the odds of getting cancer.
       Needless to say, there's not really a ``right'' decision. A 
     woman's choice just comes down to what she feels is right for 
     her body and life.
       In the past 18 months, I've gotten to check a whole lot of 
     things off my ``absolutely not on my bucket list'' bucket 
     list.
       In April 2016, I had my first breast MRI, which revealed a 
     lump that my doctor thought might be breast cancer. I then 
     had my first mammogram, my first breast ultrasound, and my 
     first breast biopsy. These tests thankfully revealed that I 
     didn't have breast cancer. They also helped me to make the 
     difficult decision to have a prophylactic mastectomy and 
     significantly reduce my chances of getting breast cancer.
       In August 2016, I had a prophylactic mastectomy. And in 
     October and February of this year, I had follow-up surgeries 
     to have my breasts reconstructed.
       Since February, I've been focusing on healing, and I feel 
     great. Obviously, this isn't the end of the road. Doctors 
     suggest that women with a BRCA-1 mutation get their ovaries 
     removed around age 40. And of course screening will continue 
     to be important. But for now, I feel at peace knowing that 
     I'm doing what I can to protect myself.
       As Senator Udall mentioned, at the time that all of this 
     health stuff came up, I had health insurance thanks to 
     Medicaid Expansion through the ACA/ObamaCare.
       I first enrolled in Medicaid about three years ago when I 
     was a law student at UNM School of Law. UNM had just given 
     qualifying students the opportunity to enroll in Medicaid 
     under the Affordable Care Act. I was a healthy 29-year-old 
     with no preexisting conditions, and doubted I would ever use 
     my health insurance. Little did I know, completing the 
     Medicaid application would be one of the most important 
     decisions I ever made.
       So, a truly genuine #thanksObama to President Obama, his 
     staff and all our elected leaders who worked to make the ACA 
     happen and are fighting to keep it alive.
       I am so grateful that I qualified for Medicaid at a time in 
     my life when I unexpectedly needed health insurance more than 
     I could have ever anticipated. I am so thankful the drafters 
     of the ACA understood that allowing me to get the preventive 
     care I needed was better for my health, and also

[[Page S3725]]

     more financially sound. The ease with which I have received 
     my medical coverage has allowed me to focus on my recovery.
       While it has been a challenging year and a half, knowing 
     that I could trust my health insurance made it so much easier 
     than I'd imagined it would be.
       I am so relieved that now I can focus on my future instead 
     of figuring out how to pay off insurmountable medical debt.
       I am fully recovered from my surgeries and am working on 
     moving my life and career forward. I look forward to paying 
     taxes (I swear, I really do) to support programs like 
     Medicaid so that I can do my part to assist other Americans 
     in staying healthy. If you had told me when I signed up for 
     Medicaid that I would make such extensive use of it, I 
     wouldn't have believed it. At times, I have felt guilty for 
     having to utilize Medicaid at a time in my life that has 
     proven to be so medically and financially complicated.
       Friends and family have been good enough to remind me that 
     this is what Medicaid is about: ensuring that Americans can 
     afford to take care of their health, regardless of their 
     financial state, when an issue strikes. The Affordable Care 
     Act has made this a reality for more people than ever before; 
     I am so grateful to be one of them.
       I am very scared for what the future will bring for those 
     many individuals who have received insurance thanks to the 
     ACA. I worry that if the [Affordable Care Act] is destroyed, 
     my preexisting condition will make it financially impossible 
     for me and many others to get health insurance.
       I worry for people who couldn't get insurance through their 
     work and were finally able to get it through the Exchange. I 
     worry that those who suffer from ailments that constantly 
     affect their health won't be able to afford the care they 
     need. I worry about the millions of Americans who are about 
     to lose so much.
       I understand that the ACA is not perfect. It needs some 
     work, especially for people on the exchange who are paying 
     premiums that are way too high. But the replacement plan that 
     is being proposed is going to make it incredibly difficult 
     for all of us to get quality, affordable coverage.
       There are no words to adequately express my gratitude to 
     all those who worked so tirelessly to make the Affordable 
     Care Act happen. I am so hopeful that instead of destroying 
     the ACA, our leaders will work to make it stronger so that 
     all Americans can get the healthcare that they deserve.

  Those are the words Elena posted on her Facebook page, very, very 
moving words. Before her surgery, Elena had an 87-percent chance of 
developing breast cancer, and now it is less than 10 percent, less than 
that of the average woman.
  I commit to Elena and to every New Mexican and American that I will 
work to make the ACA stronger so that all Americans will get the 
healthcare they rightly deserve. But the Senate Republicans cannot 
claim the same. Their bill, drafted in secret behind closed doors, 
hurts people like Elena who have preexisting conditions. It hurts 
people in her situation who have complicated healthcare needs with high 
medical costs and those who benefit from Medicaid, from the Medicaid 
expansion.
  Americans support the Medicaid Program. They understand that even if 
they don't need Medicaid, neighbors, friends, family may need it. And 
they understand that they may need it unexpectedly in the future, as 
Elena did.

  Medicaid expansion has meant that over 265,000 New Mexicans have 
healthcare coverage that they didn't have before. It is a pretty 
remarkable thing. In 6 short years in New Mexico, after the passage of 
the Affordable Care Act, we had people who didn't have any healthcare, 
and now 265,000 have Medicaid coverage. They could be in a situation 
just like Elena's. Many of these are hard-working families--families 
living in rural New Mexico and Native American families living in New 
Mexico.
  The Senate Republican bill, like the House Republican bill, will end 
Medicaid expansion in New Mexico for people like Elena.
  I want everyone listening to hear: This bill cuts Medicaid overall 
more deeply--more deeply--than the House version. And when President 
Trump said that the House version was a mean bill, this is a meaner 
bill. They are not necessary; these cuts are meaner, and they are not 
necessary to repeal the Affordable Care Act. They will hurt millions of 
Americans.
  They are also devastating to our State economies. New Mexico can't 
afford to pick up the tab for those cuts, so the State will be forced 
to cut services and reduce payments to doctors. Hospitals might close, 
and that would mean healthcare jobs will dry up.
  Elena's story is one of millions. Every Senator has hundreds of 
thousands of constituents with these stories. We all need healthcare at 
some point in our lives.
  I urge, I implore my fellow Senators across the aisle to reject the 
McConnell TrumpCare bill. Work with Democrats on a bipartisan basis to 
improve America's healthcare system so that every American has access 
to affordable healthcare.
  Don't do this. Don't gut our healthcare system.
  Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. McCONNELL. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

                          ____________________