[Congressional Record Volume 163, Number 109 (Monday, June 26, 2017)]
[Senate]
[Pages S3744-S3745]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
Healthcare Legislation
Mr. SCHUMER. Madam President, this week, the eyes of the American
people should be and are on the Senate. The Republican majority
endeavors to pass a massive remake of our Nation's healthcare system
with the votes of only one party and the ideas of only one wing of one
party in just 4 short days.
The Republican majority kept their healthcare bill shrouded in
darkness for as long as possible, only dragging it into the light last
Thursday morning after it was forced to because there was so much
outcry over the secrecy. That was only a week before it was set for a
vote. There are still no hearings and no opportunity for a robust
discussion of amendments. Just a few hours ago, they released a revised
version, which, at the moment, is what we will apparently consider on
the floor.
There is a reason my Republican colleagues labored in secret. There
is a reason they forsook the committee process and regular order and
open debate. There is a reason they want to jam this bill through in
just 1 week. They are ashamed of their bill. Now that we have seen it,
we finally know why.
The Republican healthcare bill--this new TrumpCare--unwinds the
healthcare protections and programs that are designed to help the
Americans who need it the most in order to give a tax break to the
Americans who need it the least.
The bill would gut Medicaid, making it harder for families with a
loved one in a nursing home or for families with a disabled child to
afford his care, so that they can give a massive tax cut to the
wealthy.
This bill would defund Planned Parenthood, making it harder for
millions of women to obtain care, so that they can give people who make
over $1 million a $57,000 tax cut, on average.
The bill would slash tax credits, which help families afford health
insurance, in order to give a nearly $1 trillion tax cut to the
wealthiest Americans.
The bill would also punish any Americans who experience a gap in
coverage, locking them out of health insurance for 6 months. Every
year, tens of millions of Americans have a gap in coverage through no
fault of their own. Some lose their jobs, and others have temporary
financial problems. It is inhumane to say to those Americans: You now
have to wait an additional 6 months without insurance.
Imagine someone who is struggling with cancer, and he has a lapse in
coverage. The 6-month wait this Republican penalty imposes could well
become a death sentence.
That is why Republicans are ashamed of this bill--it carries a
staggering human cost. You do not have to take my word for it; the
bipartisan National Association of Medicaid Directors came out today in
opposition to the bill, saying it would ``divert critical resources
away from what we know is working today,'' particularly for opioid
treatment.
Madam President, I ask unanimous consent that their statement be
printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
[From the National Association of Medicaid Directors, June 26, 2017]
Consensus Statement From the National Association of Medicaid Directors
(NAMD) Board of Directors on the Better Care Reconciliation Act of 2017
Washington, DC.--The following statement represents the
unanimous views of the National Association of Medicaid
Directors (NAMD) Board of Directors. NAMD is a bipartisan,
nonprofit, professional organization representing leaders of
state Medicaid agencies across the country.
Medicaid is a successful, efficient, and cost-effective
federal-state partnership. It has a record of innovation and
improvement of outcomes for the nation's most vulnerable
citizens.
Medicaid plays a prominent role in the provision of long-
term services and supports for the nation's elderly and
disabled populations, as well as behavioral health services,
including comprehensive and effective treatment for
individuals struggling with opioid dependency.
Medicaid is complex and therefore demands thoughtful and
deliberate discussion about how to improve it.
Medicaid Directors have long advocated for meaningful
reform of the program. States continue to innovate with the
tools they have, but federal changes are necessary to improve
effectiveness and efficiency of the program. However, these
changes must be made thoughtfully and deliberately to ensure
the continued provision of quality, cost-effective care.
Medicaid Directors have asked for, and are appreciative of,
improved working relationships with HHS and are working hard
to streamline and improve the administration of the program.
The Senate bill does formalize several critical
administrative and regulatory improvements, such as giving
Medicaid Directors a seat at the table in the development of
regulations that impact how the program is run, and the
pathway to permanency for certain waiver programs. However,
no amount of administrative or regulatory flexibility can
compensate for the federal spending reductions that would
occur as a result of this bill.
Changes in the federal responsibility for financing the
program must be accompanied by clearly articulated statutory
changes to Medicaid to enable states to operate effectively
under a cap. The Senate bill does not accomplish that. It
would be a transfer of risk, responsibility, and cost to the
states of historic proportions.
While NAMD does not have consensus on the mandatory
conversion of Medicaid financing to a per capita cap or block
grant, the per capita cap growth rates for Medicaid in the
Senate bill are insufficient and unworkable.
Medicaid--or other forms of comprehensive, accessible and
affordable health coverage--in coordination with public
health and law enforcement entities, is the most
comprehensive and effective way address the opioid epidemic
in this country. Earmarking funding for grants for the
exclusive purpose of treating addiction, in the absence of
preventative medical and behavioral health coverage, is
likely to be ineffective in solving the problem and would
divert critical resources away from what we know is working
today.
Medicaid Directors recommend prioritizing the stabilization
of marketplace coverage. Medicaid reform should be undertaken
when it can be accomplished thoughtfully and deliberately.
Mr. SCHUMER. Madam President, the nonpartisan American Medical
Association--a conservative organization--came out today in opposition
to the bill, saying it ``will expose low and middle income patients to
higher costs and greater difficulty in affording care.''
I ask unanimous consent that their letter be printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
American Medical Association,
Chicago, IL, June 26, 2017.
Hon. Mitch McConnell,
Majority Leader, U.S. Senate,
Washington, DC.
Hon. Charles Schumer,
Minority Leader, U.S. Senate,
Washington, DC.
Dear Majority Leader McConnell and Leader Schumer: On
behalf of the physician and medical student members of the
American Medical Association (AMA), I am writing to express
our opposition to the discussion draft of the ``Better Care
Reconciliation Act'' released on June 22, 2017. Medicine has
long operated under the precept of Primum non nocere, or
``first, do no harm.'' The draft legislation violates that
standard on many levels.
In our January 3, 2017 letter to you, and in subsequent
communications, we have consistently urged that the Senate,
in developing proposals to replace portions of the current
law, pay special attention to ensure that individuals
currently covered do not lose access to affordable, quality
health insurance coverage. In addition, we have advocated for
the sufficient funding of Medicaid and other safety net
programs and urged steps to promote stability in the
individual market.
[[Page S3745]]
Though we await additional analysis of the proposal, it
seems highly likely that a combination of smaller subsidies
resulting from lower benchmarks and the increased likelihood
of waivers of important protections such as required
benefits, actuarial value standards, and out of pocket
spending limits will expose low and middle income patients to
higher costs and greater difficulty in affording care.
The AMA is particularly concerned with proposals to convert
the Medicaid program into a system that limits the federal
obligation to care for needy patients to a predetermined
formula based on per-capita-caps. At the recently concluded
Annual Meeting of the AMA House of Delegates, representatives
of more than 190 state and national specialty medical
associations spoke strongly in opposition to such proposals.
Per-capita-caps fail to take into account unanticipated costs
of new medical innovations or the fiscal impact of public
health epidemics, such as the crisis of opioid abuse
currently ravaging our nation. The Senate proposal to
artificially limit the growth of Medicaid expenditures below
even the rate of medical inflation threatens to limit states'
ability to address the health care needs of their most
vulnerable citizens. It would be a serious mistake to lock
into place another arbitrary and unsustainable formula that
will be extremely difficult and costly to fix.
We are also concerned with other provisions of the
legislation beyond those directly affecting insurance
coverage. The Affordable Care Act's Prevention and Public
Health Fund was, according to the Department of Health and
Human Services, established to ``provide expanded and
sustained national investments in prevention and public
health, to improve health outcomes, and to enhance health
care quality.'' These activities are key to controlling
health care costs and the elimination of support for them
runs counter to the goal of improving the health care system.
We also continue to oppose Congressionally-mandated
restrictions on where lower income women (and men) may
receive otherwise covered health care services--in this case
the prohibition on individuals using their Medicaid coverage
at clinics operated by Planned Parenthood. These provisions
violate longstanding AMA policy on patients' freedom to
choose their providers and physicians' freedom to practice in
the setting of their choice.
We do appreciate the inclusion of several provisions
designed to bring short term stability to the individual
market, including the extension of cost sharing reductions
payments. We urge, however, that these provisions serve as
the basis of Senate efforts to improve the ACA and ensure
that quality, affordable health insurance coverage is within
reach of all Americans.
We sincerely hope that the Senate will take this
opportunity to change the course of the current debate and
work to fix problems with the current system. We believe that
Congress should be working to increase the number of
Americans with access to quality, affordable health insurance
instead of pursuing policies that have the opposite effect,
and we renew our commitment to work with you in that
endeavor.
Sincerely,
James L. Madara, MD.
Mr. SCHUMER. Madam President, even several Republican Senators are
expressing concerns.
Republican Senator Heller said: ``The bill doesn't protect the most
vulnerable Nevadans--the elderly, Nevadans struggling with mental
health issues, substance abuse, and people with disabilities.''
He continued: ``The goal of healthcare reform should be to lower
costs here in Nevada, and I'm not confident--not confident--it will
achieve that goal.''
Republican Senator Susan Collins said about the bill: ``I'm very
concerned about the cost of insurance for older people with serious
chronic illnesses, and the impact of the Medicaid cuts on our state
governments, the most vulnerable people in our society, and health care
providers such as our rural hospitals and nursing homes.''
Even my friend the junior Republican Senator from Texas said that
under this bill, ``premiums would continue to rise.''
My Republican friends are right to have these concerns. The bill will
not lower costs for working families. It will leave the most vulnerable
Americans out in the cold, devastate rural areas, and set us even
further back in combating the opioid epidemic.
This week, the Senate will witness a political exercise in that the
majority leader will attempt to coerce the votes of these Senators and
any other holdouts by adjusting the dials on the legislation a bit.
There will be buyouts and bailouts and small tweaks that will be hailed
as ``fixes'' by the other side.
The truth is that the Republicans cannot excise the rotten core at
the center of their healthcare bill. No matter what tweaks they add, no
matter how the bill changes around the edges, it is fundamentally
flawed at the center. No matter what last-minute amendments are
offered, this bill will force millions of Americans to spend more of
their paychecks on healthcare in order to receive fewer benefits simply
so that the wealthiest Americans can pay less in taxes. That is why our
Republican colleagues are ashamed of this bill and are rushing it
through in 4 short days.
Before we vote on the motion to proceed, I would ask my Republican
friends to do one simple thing: Reflect on how this bill would impact
your constituents. We are all sent here to serve the people of our
States--to do right by them, to ease their burdens where possible and
make sure our laws reflect a country that gives everyone an equal
opportunity to succeed. The first rule of medicine is ``do no harm.''
So it should be with government. So it should be with this healthcare
bill.
But this bill will harm the middle-class family with a parent in a
nursing home. It will harm the father whose son is struggling with
opioid addiction and who is having trouble finding the money to put him
through treatment. It will harm the child born with a preexisting
condition, who may hit the lifetime cap on healthcare coverage before
he or she even enters kindergarten.
As the American Medical Association said today, this bill violates
the ``do no harm'' standard on many levels. I believe my friends and
colleagues on the other side of the aisle are men and women of good
conscience. I would ask that they think with their conscience before
they vote on the motion to proceed on Wednesday.
Any bill that does this much harm to the American people ought to
receive a ``no'' vote.