[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.