[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
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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
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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.
____________________