[Congressional Record Volume 163, Number 109 (Monday, June 26, 2017)]
[Senate]
[Pages S3747-S3750]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                         Healthcare Legislation

  Mr. REED. Mr. President, I come to the Senate floor, once again, to 
urge my colleagues to work in a bipartisan, transparent fashion to 
improve our healthcare system and help bring down costs.
  Over the weekend, members of the American Medical Association--the 
Nation's largest organization of doctors--had a chance to finally read 
the proposed Republican bill and found it violates their ``do no harm'' 
principle. According to a letter they wrote to Leaders McConnell and 
Schumer, ``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.''
  That is the conclusion of the American Medical Association, and they 
are correct. This bill will not lower costs, and it will not improve 
our healthcare system. Instead, it will remove health insurance 
coverage for millions of Americans. Indeed, the CBO has just released 
their estimate that 22 million Americans will lose their health 
insurance coverage. It will increase costs for everyone and decimate 
State budgets, creating a ripple effect throughout our economy.
  The bill my colleagues worked in secret to craft is, in a sense, a 
sham. It will not lower costs, and it will not improve our healthcare 
system, as they insist. Instead, it will remove health insurance 
coverage for millions of Americans--22 million, according to the CBO--
increase costs for everyone, as I said, and decimate State budgets. In 
fact, their bill essentially is a huge tax cut for the wealthiest 2 
percent of Americans at the expense of everyone else.
  If you need any further proof of the real driver of this bill, one of 
its biggest giveaways is a retroactive tax break on investment income 
for people making at least a quarter of a million dollars. Dozens of 
leading economists, including six Nobel laureates, have criticized this 
plan as, in their words, a ``giant step in the wrong direction'' that 
prioritizes tax breaks averaging $200,000 annually per household in the 
top 0.1 percent of Americans over the well-being of working families. 
In fact, President Trump himself will get an estimated $2 million tax 
break each year from the giveaways in this bill. Let's call this bill 
what it is: a massive giveaway to the wealthiest Americans. Meanwhile, 
the rest of the country--all of our constituents--will be the ones 
paying the price for these tax breaks for those well-off. So much for 
the President's claim that he would end a rigged system.
  Now, how do Republicans pay for these tax breaks? For starters, they 
are proposing to end the Medicaid expansion under the Affordable Care 
Act, which is providing health insurance to nearly 15 million 
Americans, but then they go even further by effectively block-granting 
Medicaid, cutting hundreds of billions of dollars from the program over 
the next decade. These are not reforms designed to lower costs. This is 
a cut, pure and simple, which will sharply curtail and eliminate needed 
healthcare services to many across this country. In fact, the Center on 
Budget Policies and Priorities published data that shows a stark 
contrast of who gains and who loses under this bill. The 400 households 
in the country with the highest incomes will get tax breaks totaling 
$33 billion because of the Senate TrumpCare bill. As a result, over 
725,000 Americans will lose Medicaid coverage in just four States to 
equate to that $33 billion: Alaska, Arkansas, Nevada, and West 
Virginia. That doesn't even scratch the surface as to who will lose 
access to care in the remaining 46 States.
  Medicaid has played a critical role in ensuring access to care for 
millions of Americans, including children, seniors, and people with 
disabilities. In fact, across the country, and in my home State of 
Rhode Island, about half of all Medicaid funding is spent on nursing 
home care. Over 60 percent of nursing home residents access care 
through Medicaid. If you think nursing home care will be protected, you 
are in for a rude awakening because the math just doesn't work. It will 
be impossible to cut Federal funding for State Medicaid programs by 
hundreds of billions of dollars and not impact the most significant 
Medicaid expenditures, which are nursing homes.
  I would also like to talk about the role Medicaid plays in 
emergencies like a recession or public health crisis. We know all too 
well how an economic downturn impacts communities. With job loss, comes 
loss of health insurance, pensions, and other benefits. The tax base 
shrinks, and State budgets suffer. Medicaid, as currently structured, 
is able to adapt to this. As the need increases, the program grows to 
cover everyone who is eligible, including those who have just lost 
jobs. This saves families from having to choose whether to take their 
kids to the doctor or put food on the table.
  Under the Senate TrumpCare bill, States will be hamstrung by 
arbitrary caps and limits on Medicaid. In fact, States will be unable 
to expand coverage during a recession to those in need, and they will 
likely have to make cuts across the board, from healthcare and 
education to transportation infrastructure, to make up for the lost tax 
revenues. This is not strictly going to be an issue of healthcare 
policy in States. The cuts are so dramatic that after they have taken 
all they can from other healthcare programs, they will inevitably go to 
education funding--the biggest expense most States have--and then to 
transportation and then to public safety. Even then, I don't think they 
can keep up with these cuts.
  Like most of the country, Rhode Island was hard hit by the recession. 
It took many years for the economy to even begin to turn around in the 
right direction. It seemed my colleagues are forgetting how Medicaid 
has been a critical safety net through tough economic times.
  I am also concerned that my colleagues are not aware of the impact 
Medicaid has on our Nation's veterans. The uninsured rate among 
veterans has dropped by 40 percent since implementation of the 
Affordable Care Act. Nationwide, nearly 1 in 10 veterans is covered by 
Medicaid, including approximately 8,000 veterans in my home State of 
Rhode Island. The cuts to Medicaid that have been proposed by my 
Republican colleagues put the care of our veterans at risk. We have all 
promised to provide the best care possible to our brave men and women 
when they leave the service, but the Senate TrumpCare bill would do the 
opposite.
  That is not the only way this bill would damage veterans' care. Many

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veterans seek help for mental health care by going outside of the VA 
system. TrumpCare puts mental health and substance abuse treatment at 
risk by saying insurance companies no longer need to cover these 
services. For the over 15,000 veterans in Rhode Island who access 
mental and behavioral healthcare outside of the VA, they would be out 
of luck. For all the bipartisan work in this Chamber to increase 
veterans' access to these services, it would all be for naught if 
Senate Republicans pass their TrumpCare bill.
  These are just some of the things Republicans are sacrificing in the 
name of tax breaks for the wealthy. It is, frankly, unconscionable. 
More importantly, this will not be lost on the American people. I have 
heard from thousands of my constituents since the beginning of this 
year, and if Senate Republicans press forward with this legislation, I 
think we will all hear from many more of these constituents for many 
years to come.
  TrumpCare is fundamentally flawed and cannot be fixed. We would 
welcome the opportunity to work across the aisle on improvements to the 
Affordable Care Act, like those to lower costs, especially prescription 
drug costs, any time.
  I, once again, urge my colleagues to drop their efforts and to work 
with us to instead make improvements to the ACA.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Florida.
  Mr. NELSON. Mr. President, last week, I spoke with a very brave 
mother. She had endured what not one of us ever wants to have to endure 
while she watched her child go through cancer, over and over and over 
again. That mother is Elaine Geller from my State of Florida. I want to 
show you her daughter. This is her daughter Megan. She was working as a 
kindergarten teacher when she was diagnosed with leukemia in 2013 at 
the age of 26. At the time Megan was admitted to the hospital, her 
blood count was four. She had pneumonia, and she had water on her 
heart.

  She ultimately checked into one of the very good cancer centers at 
the University of Miami, and she stayed there for 7 months. She went 
through the regimen of chemo. She spent months in the hospital, 
receiving multiple rounds of chemo, biopsies, and various other 
treatments. Eventually, Megan's doctor told her she had to have a 
transplant, which required a $150,000 upfront payment. I think you see 
where I am going with this story. Very few families would be able to 
afford a 150-grand payment, especially a single mother.
  I heard this story last week from Megan's mother. She said that 
thanks to the Affordable Care Act, she didn't have to write a check for 
the transplant. In fact, she didn't have that money. Because that 
transplant was provided for under the Affordable Care Act coverage, she 
knew that was one worry that could be taken off of her mind. She had 
enough to worry about as a mother, what she should be doing in such a 
situation, and of course she wanted to give all of her attention to her 
daughter.
  The cancer went into remission after the transplant; however, after 
leaving the hospital, 63 days later, the cancer came back. This time, 
they went to MD Anderson Cancer Center in Houston. I asked the mom why 
she wanted to do that. She said: ``When your child is dying, there's 
nothing that you won't do.'' I think all of us as parents can identify 
with that, but we are so very fortunate that we haven't had to go 
through it.
  Maybe, as we get ready to vote on this healthcare bill, on the 
Republican alternative--which, by the way, just came out of CBO today--
the Congressional Budget Office--and they said that if the Senate bill 
were enacted, 22 million people would lose health insurance coverage. 
Remember, that is not too much different from what CBO said when the 
House bill was passed a couple of months ago, the bill to which there 
has been such a negative reaction. CBO said that 23 million people in 
this country would lose their coverage as a result of the House bill. 
We just got the score from CBO minutes ago. Twenty-two million people. 
Is that the direction we want to be going in?
  Megan is still going through treatment, and the cancer was only in 
remission for 32 days before it came back again. Megan received 
multiple blood transfusions. Remember, this is a single mom trying to 
keep her daughter, a schoolteacher in her twenties, alive. This time, 
all of the blood transfusions started to take another toll on Megan. 
She became so weak. When trying to walk, she faltered, she fell, she 
hit her head, and at age 28, she passed away.
  Let's get to the bottom line of this discussion, other than that our 
hearts go out to all the Megans all across America. The bottom line is, 
that whole treatment over 2 years cost $8 million. There was not a cap 
on the total amount of money that could be paid under the existing law, 
the Affordable Care Act. An insurance company cannot put a cap on the 
amount of your medical bills that can be reimbursed. Suppose before the 
ACA that cap was $50,000. This single mom could not even have come up 
with money for the initial transplant, which looked as though it worked 
and did work for several months. In fact, $8 million over time--2 
years--how in the world could any one of us afford that?
  A lot of people say: Well, the ACA isn't doing it. Well, why don't we 
all get together in a bipartisan way and fix it? And one of the fixes 
would be, because certain healthcare problems, like Megan's, cause the 
insurance company to pay out a lot of money--do you know what we can do 
about it? We can create a reinsurance fund, which is a bill that I had 
filed, and it is to reinsure against that catastrophic healthcare 
problem like Megan's of $8 million, to reinsure the insurance company. 
Do you know what that would do in the State of Florida, if we passed 
this as a fix to the ACA? It would lower the premiums in the ACA in 
Florida 13 percent. That is reinsurance.
  It is not unlike what we have done for hurricanes. A catastrophic 
hurricane could cost so much more than the insurance company has assets 
for, and therefore they buy insurance from a company like Lloyd's of 
London or other reinsurance companies. They buy insurance in case of a 
catastrophe--the insurance company does that. If an insurance company 
did not have to pay out this $8 million because it had insured against 
that kind of catastrophic loss, everybody else's premiums are going to 
come down. Otherwise, they have to make premiums actuarially sound, and 
they have to raise them in order to take care of the cases that are 
prohibitively expensive.
  All of this sounds down in the weeds, but the bottom line is this: If 
we want to fix the ACA, we can fix it, but we can't do it one party 
against the other. We have to have the will to come together in a 
bipartisan agreement to fix it.
  Of course, if the mom of this girl had been faced with this without 
insurance coverage, she would be bankrupt. She wouldn't have been able 
to even afford the first transplant, much less the 2 years of extra 
life her daughter had while fighting for her life. Anybody who goes 
through something like Elaine and her daughter Megan did knows that 
every second counts.
  That is what this healthcare debate is about--giving people peace of 
mind, giving them that financial security, that certainty, putting 
people's health ahead of other things, such as company profits. You can 
do it all and solve everybody's problem, including the insurance 
company's, which obviously is in business to make a profit. You can do 
it.
  Elaine said her daughter would be proud to know that we are telling 
that story today. It matters. It matters to her, albeit deceased. It 
certainly matters to her mom. It matters to their Senator. It matters 
to a lot of other people.
  The ACA, the existing law--the one there was such a fractious fight 
over 5 to 7 years ago--is working. Here is a good example. Then we see 
that the aim of our friends on that side of the aisle is--they want to 
repeal it. They don't want anything that has the taint of ObamaCare, 
and so they concoct something in the House. You see what kind of 
greeting that has gotten in the country. I think it was in the upper 
teens--a poll that showed it was viewed favorably. In other words, it 
is viewed very unfavorably.
  In order for the Senate majority leader to come up with something 
that he can repeal ObamaCare with, in the dead of night, in secret--
even the Republican Senators didn't know what it

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was until they hatched it in the public last Friday. This bill is just 
as bad as the House bill.
  They will claim, in trying to stand up this bill--by the way, it is 
going to wither, the more it is examined in the glare of the spotlight. 
They claim that it maintains the ACA's protections for those with 
preexisting conditions. Can anybody really say that with a straight 
face? It leaves it up to the States.
  Before I came to Washington and the Senate service, I was the elected 
insurance commissioner, State treasurer of Florida. It was my job to 
regulate the insurance companies--all kinds of insurance companies, 
including health insurance companies. I can tell you that I have seen 
some insurance companies use asthma as a preexisting condition, and 
therefore that was the reason they would not allow the person who 
needed insurance to be covered. They said: If you have a preexisting 
condition, we are not going to insure you. I have even seen insurance 
companies use as an excuse a rash as a preexisting condition, and that 
means they are not going to insure you. Under the existing law, the 
ACA, they can't do that. You are going to have the security of knowing 
you are going to have coverage.
  Do you know something else you are going to have the security of 
knowing? You are not going to deal with some of those insurance 
companies that I regulated. Of your premium dollar for health 
insurance, they would spend 40 percent of that dollar not on your 
healthcare, but they would take 40 cents of that premium dollar that 
you paid and that was going to executive salaries. It was going to 
administrative expenses. It was going to plush trips. Don't tell me 
that is not a true story. I saw it over and over in the 1990s as the 
elected insurance commissioner of Florida.

  You know what the existing law says? It says that of every premium 
dollar you pay, 80 cents of that premium dollar has to go into 
healthcare. It can't be commissions. It can't be executive salaries. It 
can't be the executive jets for the corporate executives. Eighty cents 
of that premium dollar has to go into healthcare so you get what you 
pay for in that premium dollar. At some point there is going to be an 
attempt to undo that. If you start leaving things up to the States, 
watch out.
  When Megan was in the ICU, she had a respiratory failure that cost 
thousands of dollars more, and thanks to the ACA, her insurance carrier 
covered it. But under the Republican bill that has been now released, 
States could let their insurance companies pocket more of those premium 
dollars to pay for those things I just shared, which I had seen back in 
the decade of the 1990s as the insurance commissioner. Well, we 
shouldn't be padding their pockets. The premium dollar for health 
insurance ought to go to healthcare.
  The Senate bill cuts billions in Medicaid. We haven't even talked 
about that. Who gets Medicaid? Millions of people in this country do. 
It is not only the poor. It is not only the disabled. It is 65 to 70 
percent of all seniors in nursing homes who are on Medicaid, and it is 
also some children's programs. Let me just give you one example. I went 
to the neonatal unit at Shands Hospital in Jacksonville, a hospital 
affiliated with the University of Florida, but in Jacksonville. The 
doctors and nurses were showing me how miracles occur for premature 
babies; they keep them alive.
  Then what they wanted to show me was--with the opioid epidemic, which 
has hit my State just like all the other States, they wanted me to see 
and understand that when a pregnant mom is addicted to opioids, she 
passes that on in her womb to her unborn child. When born, that baby is 
opioid-dependent. The doctors showed me the characteristics--that high, 
shrill cry, the constant scratching, the awkward movements. Do you know 
what they use to wean those little babies off opioids over the course 
of a month? They use doses of morphine.
  Do you want to devastate Medicaid? Do you want to take over $800 
billion over 10 years out of Medicaid? What about those single moms? 
The only healthcare they get is Medicaid. And what about those babies I 
just described, who are also on Medicaid? If you start capping the 
amount of money that goes to the States on a Federal-State program for 
healthcare--Medicaid--you are going to throw a lot of people off any 
kind of healthcare, including senior citizens in nursing homes.
  A Medicaid block grant, or a cap, would end the healthcare guarantee 
for millions of children, people with disabilities, pregnant women, and 
seniors on long-term care. There are 37 million children in this 
country who rely on Medicaid for care. The seniors, the poor, the 
disabled, the children--they are all vulnerable to the cuts that would 
occur.
  If that is not enough to vote against this bill that is coming to the 
floor this week, the Senate bill actually imposes an age tax for older 
Americans, allowing insurance companies to charge older Americans up to 
five times more for coverage than a young person. You say: Well, older 
people have more illnesses and ailments; older people ought to cost 
more. If that is your argument, well, that is true.
  The age rating in the existing law, the ACA, is three to one. This 
changes it to five to one, and five to one means one thing: higher 
premiums for senior citizens--I am talking about all insurance 
policies--until they reach that magic age of 65 and can be on Medicare. 
Do you want an age tax on older Americans as a result of this bill? I 
don't think so. But that is what is in there.
  Fixing our Nation's healthcare system shouldn't be a partisan issue. 
That is why I have joined--bipartisan--with colleagues to introduce a 
bill that I described a moment ago, which would lower healthcare 
premiums by 13 percent. That bill would stabilize the ACA's insurance 
marketplace through the creation of a permanent reinsurance fund. I 
have seen the policies work, as I described, with catastrophic 
hurricane insurance. There is nothing magic about my idea. It is just 
an obvious fix to the existing law, and ideas like that can bubble 
forth in a bipartisan way to make the existing law that we have 
sustainable.
  What we ought to be doing is trying to look for ways to help people 
like that single mom Elaine and her daughter Megan. We should be 
working together to make the ACA work better. We shouldn't be plotting 
behind closed doors in the dead of night with a secret document--a 
secret document that we now know will make it worse.
  I yield the floor.
  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. CARPER. 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. CARPER. Mr. President, it is good to see you this afternoon.
  I rise in support of the nomination of Kristine Svinicki to hold a 
third term as a member of the Nuclear Regulatory Commission, known as 
the NRC. Many Senators heard from our chairman on the Environment and 
Public Works Committee in support of this nominee last week, just prior 
to our cloture vote. I want to add my voice in support of her 
nomination as well.
  Since joining the Environment and Public Works Committee, I have 
worked closely with my colleagues to strengthen what we call the 
``culture of safety'' within the U.S. nuclear energy industry. In part, 
due to our collective efforts and the NRC leadership and the 
Commission's dedicated staff, the NRC continues to be the world's gold 
standard for nuclear regulatory agencies. However, as I say time and 
again, that does not mean we can become complacent when it comes to 
nuclear safety and our NRC oversight responsibilities, a perspective 
that I am certain is shared by every Member of this body.
  Ensuring that the Nuclear Regulatory Commission continues to have 
experienced and dedicated leadership is one of the most important 
things that our committee, the Committee on Environment and Public 
Works, and the Senate can do to maintain a high level of safety and 
excellence in our Nation's nuclear facilities.
  I am quite impressed with our NRC Commissioners, and I am encouraged 
with their ability to work cooperatively with each other. Each 
Commissioner, including our current chair, Kristine Svinicki--let me 
say her name again: Svinicki. People have a hard time saying her name. 
It is Svinicki.

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She brings a unique set of skills to the table--something that has 
served the Commission and our country well.
  I continue to have ongoing discussions with our friend, the chairman 
of the committee, Senator John Barrasso, about the strong interest I 
and our minority members of the committee have with ensuring parity, as 
the Senate looks to confirm other nominees to the NRC. This is in order 
to ensure that we have a balance of Democratic and Republican members 
on the Commission for years to come. It continues to be a priority for 
me and our Democratic colleagues.
  At this time, I support moving Chairman Svinicki through the 
confirmation process. I do so out of respect for her long service to 
the NRC and for the need to ensure certainty and predictability within 
the NRC and its leadership. I hope my colleagues will join me in 
supporting her nomination.
  Mr. President, as to this particular nominee, not everybody on the 
committee or probably in the Senate will support the nomination of 
Kristine Svinicki. They could have held her up. No one has, and she has 
moved through our committee expeditiously. She, in my view, should have 
moved through expeditiously and will be coming before us for an up-or-
down vote in a few minutes.