[Congressional Record Volume 163, Number 109 (Monday, June 26, 2017)]
[Senate]
[Pages S3768-S3779]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                         HEALTHCARE LEGISLATION

  Mr. BLUMENTHAL. Mr. President, I am proud to be on the floor today, 
proud to stand with my colleagues, and I hope that at the end of this 
week, I will be proud of all of my colleagues when we vote to defeat 
this measure, or at least to delay it, because we owe the American 
people the right to be heard.
  Our responsibility as elected representatives is at the very least to 
listen. I have been listening over the last week but really over the 
last year to constituents of mine in the State of Connecticut and over 
the last week at two emergency field hearings that I conducted because 
no hearings were held by the Senate and no markups and no votes in 
committee. What we saw here in Washington was complete secrecy, a bill 
produced behind closed doors, only seeing the light of day for the 
first time last Thursday.
  Our Republican colleagues have gone from total secrecy to total 
chaos. The reason for the chaos is the facts that were most 
dramatically revealed today--just hours ago--when the Congressional 
Budget Office told us, not surprisingly, that 22 million Americans 
would be thrown to the wolves as a result of this measure--thrown to 
the wolves of no healthcare coverage--and eventually 49 million 
Americans would be without healthcare insurance by 2026.
  Next year alone, 15 million more people will be uninsured under the 
Republican plan, TrumpCare 2.0. Low-income Americans would be unable to 
afford any plan at all, and anybody who does would be paying higher 
costs for fewer services of lesser quality. Americans will pay a higher 
share of their income and receive less as a result. A 64-year-old 
making almost $57,000 will go from paying $6,800 under the Affordable 
Care Act to $20,500 under the proposal before this body. This jump in 
cost is absolutely staggering.
  It will destroy the financial well-being of middle-class Americans 
who also, when they need nursing home care, after they have exhausted 
their savings, will be thrown to the wolves. I visited one such 
facility just last Friday, where two-thirds of its 60 beds will be 
unaffordable when those middle-class families find their savings will 
no longer cover it.
  These facts are the reason for the Republican chaos. One of our 
former colleagues, my mentor, Senator Daniel Patrick Moynihan, famously 
said: ``Everybody is entitled to his own opinion, but not to his own 
facts.'' The administration's statement that the CBO is not to be 
blindly trusted--nobody has to trust the CBO blindly. Those facts are 
driven by reality. Their report speaks truth to power and to the 
American people, and the American people get it.
  None of us can look our constituents in the eye, look ourselves in 
the mirror, look inside ourselves, in our hearts, and justify a vote 
for this bill. The American people are angry, many of them because we 
are even considering it. It is not an anger that is kind of a shrug of 
the shoulders; it is a deep, vocal, vehement, vitriolic anger. I have 
seen it and heard it at those hearings, where I listened to people 
coming forward and talking about this bill, recognizing it for what it 
is. It is not a healthcare bill; it is a massive tax cut for the 
wealthy.
  Just Friday afternoon, one of the folks who attended the hearing came 
to the microphone and said: Don't call it a healthcare bill; it is a 
wealth care bill. In fact, she is absolutely right. This bill cuts 
hundreds of millions of dollars in taxes for the richest so that they 
will do better, but it also cuts $800 billion in Medicaid spending and 
investment to provide for that kind of tax cut. It is not a healthcare 
bill; it is a wealth care bill. And for most Americans, it is a 
catastrophic, cruel, and costly insult to their intelligence, their 
health, and our American values. It is a sham and a charade, making 
possible those cuts for the rich--tax cuts for them--at the expense of 
our most vulnerable citizens. And it has been the result of a 
profoundly undemocratic process--secrecy and speed.
  Despite the best efforts of our Republican colleagues to keep 
Americans in the dark about what this proposal would do, I have seen 
growing awareness, again, not only at these hearings but as I walk 
through the airport, as I march in parades--twice over this weekend--as 
I attend public gatherings. Whether it is Boys State, sponsored by the 
American Legion for 16- and 17-year-olds, or nursing facilities for 
elderly citizens, there is a growing awareness that this bill is bad--
profoundly bad--for the American people.
  The people I have heard from have prescriptions to fill, appointments 
to make, lives to live, but they have come to these hearings on very 
short notice in Hartford and in New Haven, literally filling rooms so 
that there was standing room only.
  I challenge my colleagues to hold the same kinds of hearings, to 
delay this vote so that they can go home at the end of this week and 
hold hearings in their State and listen to their constituents about 
what they have to say and what the consequences will be.
  Nearly 1 in 10 veterans has Medicaid coverage, meaning that a 
staggering 1.75 million veterans, including 18,000 veterans in 
Connecticut, would be impacted by these reckless cuts. Let me repeat 
that number for all of us who rejoiced in the recent Accountability and 
Whistleblowers Act. Some 1.75 million veterans--18,000 of them in 
Connecticut--will be harmed by this reckless and needless insult and 
injury.
  Put simply, this bill would make it hard for veterans with mental 
health disorders like post-traumatic stress disorder to get care. 
Nearly a quarter of all veterans receive care for mental health 
disorders outside the VA system, meaning they rely on protections that 
guarantee their access to affordable care. Under this proposal, those 
protections would be severely threatened, and the veterans who need 
that care would see that care at risk.
  Here we are talking about a choice program that enables veterans to 
seek care outside the VA system, privately, and we are endangering care 
for millions of Americans--veterans--who need and seek it by using 
Medicaid.
  If my colleagues listen to their constituents, they will hear from 
many of the people who have come to my townhalls, like Christine 
Girassi. Christine has two beautiful 4-year-old twins named McKenzie 
and Cameron. McKenzie was born with Prader-Willi syndrome, a rare 
genetic disorder that her mom described as ``including low muscle tone, 
seizures, temperature instability, sleep apnea, infertility, OCD, 
intellectual disabilities, and developmental delay.''
  In the first few weeks of her life, McKenzie was in the hospital for 
57 days, accounting for $2 million in costs. Their family was spending 
$30,000 a year to help their daughter thrive. So when Christine learned 
that her daughter had received a waiver to become a Medicaid 
beneficiary, she was overjoyed.
  Christine told me:

       When we received McKenzie's diagnosis, we were told that 
     she wouldn't do a lot of things, and at only 4 years old 
     she's already defying the odds. I have no doubt in my mind 
     that if we are able to continue down our current path of the 
     proper therapies and doctors, McKenzie will be able to have 
     her fruitful life. I am terrified if the rug comes out 
     beneath her that she will become just another statistic.

  Another statistic? There are enough statistics in that CBO report. We 
will hear a plethora of statistics on the

[[Page S3769]]

floor, but a picture is worth a thousand words and many more than a 
thousand statistics, and no one--no one should be consigned to being a 
statistic.
  This family is one of the many faces and pictures and stories of 
Medicaid. They deserve to be heard. If we gut this program, if we strip 
away the important services it provides, we know all too well what will 
happen to McKenzie and her family as statistics. Like her mother said, 
Medicaid has been the path to success for them, and that rug will be 
pulled from that family, from beneath McKenzie.
  At the hearing on Friday in New Haven, I heard from Kent O'Brien, who 
told me about the eight prescription medications he takes--four for 
psychiatric reasons and four for medical reasons.
  Of course, mental health parity has been one of the crusades of my 
life. When I was State attorney general, I worked with Senator Ted 
Kennedy and Congressman Patrick Kennedy to help advocate for that bill. 
As a Senator, I advocated for the regulations that were necessary for 
its enforcement, and we finally got it done.
  I want to quote what Kent said directly. He told me:

       Hi, everybody, how are you today? I'm going to keep this 
     brief, because I know the senators are on a very strict time 
     constraint and I respect that. So I'm just going to talk very 
     quickly about my prescription medications; there are eight of 
     them. Four of them are for psychiatric reasons and four are 
     medical. And if I lose my Medicare and Medicaid, I will be 
     unable to pay for them obviously, which in turn I will end up 
     in the hospital.

  Kent went on:

       Now, for the Republicans who are seeing this in Washington, 
     can you please listen to me carefully?

  I am speaking to an empty Chamber. Let nobody make any mistake that 
Republicans are hanging on Kent's words as I speak now, but every one 
of them should go to the Record. Every one of them should be listening 
in their offices. Every one of them should go to the Record.
  Kent goes on:

       If I lose that medication, I will end up in the hospital, 
     and it's going to cost the state and the federal government 
     much more money than it would be to simply let me go to the 
     pharmacy and pick up my medication.

  If there were ever a message that Washington should hear, it is from 
Kent O'Brien, who closed by simply saying:

       So I'm just going to close up with that, and don't hurt the 
     American people. Help them!

  If you met Kent, you would wonder how he was capable of that 
eloquence. He is an ordinary American, someone who looks like all the 
rest of us. He has said to this body what it means to hear: ``Don't 
hurt the American people.'' He couldn't be more right. This proposal 
would cost our Nation so much, not just financially--Kent had it 
right--but morally. It will lead to a weakening of what makes our 
country strong and great in the first place: our ability to care about 
our neighbor, to fight for what is right, and to listen to the people 
who represent here in the Senate.

  First, do no harm. That is what the ethos of the medical profession 
is. It ought to be our mantra as well. It ought to be what my 
colleagues, if nothing else, heed as we reach this decision to listen 
to people who sent us here and hear their stories. Listen to the 
anxieties and fears and value of America. They will tell you all you 
need to know about this bill. Kent told me. As he said, the cost will 
be staggering--not just in financial terms but in human terms.
  This bill--written behind closed doors, away from the light of day, 
away from the realities of medical care in the United States of 
America, away from the voices and faces I have brought to the floor 
today, and which I will continue to bring to the floor--ignores the 
most important thing we can do this week. As Kent said, don't hurt the 
American people. As the doctors tell us: First, do no harm.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Tillis). The Senator from Maryland.
  Mr. VAN HOLLEN. Mr. President, I wish to start by thanking my 
colleague from the State of Connecticut for bringing those powerful 
testimonies to the floor of the Senate. It is really important that all 
of us--all 100 of us--spend time back home in our States listening to 
people who are telling us those kinds of stories.
  I have received over 2,500 calls in my office just since Thursday, 
all of them strongly opposed to this so-called healthcare proposal.
  Some things improve with time. Some things improve with age, like red 
wine. Some things get stinkier and smellier the longer they sit out 
there, like rotten things. That is the case with the series of 
Republican so-called healthcare bills, TrumpCare 1, TrumpCare 2.0, and 
now, TrumpCare 3.0. They are all rotten to the core, and the more they 
sit out there, the stinkier they get, and the American people know it.
  If you had any doubts, take a look at the most recent Congressional 
Budget Office report we got today. There is a pretty clear pattern 
between all of these Congressional Budget Office reports and the first 
bill we saw and the second bill and now on this latest version.
  Here is the pattern. Tens of millions of Americans will lose access 
to affordable healthcare in the United States of America in order to 
provide tax breaks for powerful special interests and richer Americans. 
That is the pattern. In this most recent report, we are told by the 
nonpartisan professionals at the Congressional Budget Office that 22 
million of our fellow Americans are going to lose access to affordable 
healthcare. For what? To give powerful special interests and wealthy 
Americans a tax break.
  Insurance companies currently are not allowed to deduct the bonuses 
they pay to their CEOs. Now you are going to allow insurance companies 
to deduct the bonuses they pay to CEOs, and while tens of millions of 
Americans will lose access to affordable care, millionaires in America 
will get an average annual tax break of $50,000 a year, every year.
  So make no mistake. You can call this a healthcare bill, but it has 
nothing to do with healthcare and everything to do with wealth care and 
transferring wealth from more struggling vulnerable Americans to the 
very wealthy.
  If this were about healthcare, why is it that we have all received in 
our offices long lists from patient advocacy organizations that are 
dead-set against this legislation? These are organizations that have 
been dedicated to trying to improve healthcare for people and patients 
in our country: the American Cancer Society, the American Diabetes 
Association, the American Heart Association, the American Lung 
Association, National Alliance on Mental Illness, National Breast 
Cancer Coalition, and National Multiple Sclerosis Society. The list 
goes on and on from organizations that have dedicated themselves to 
advancing patient health.
  On the other side, I haven't seen a single--not one--patient advocacy 
group that has come out to support this so-called healthcare bill. How 
can that be? If this is good for the health of our fellow citizens, why 
is it we have a long list of organizations dedicated to that cause 
against it and not one for it?
  How about healthcare providers, the folks who help provide the care 
to our constituents? They are all dead-set against it: the nurses, the 
doctors, the hospitals, the people who have that network of care.
  I was just out on the Eastern Shore of Maryland, a rural part of our 
State. The National Rural Health Association is opposed to this bill. 
They know the people they serve are going to be badly hurt, and, by the 
way, it is also going to hurt the economies in those parts of our 
State, especially the rural parts of the States, because those 
hospitals depend heavily on many of the people who get help through the 
Affordable Care Act, whether through the exchanges or through expanded 
Medicaid. As those patients come in the door and no longer can pay for 
their care, those hospitals said they may have to close down operations 
and lay people off. It is a double whammy--bad for patients and bad for 
those who provide the care to our patients.
  That is why AARP has been all out against this, because they know 
that for Americans between the ages of 50 and 64, before you get on 
Medicare, this is a total disaster. As they have said, there is an age 
tax. If you are older, you are going to pay a whole lot more under this 
Republican bill than you pay today.

[[Page S3770]]

  Many people are just realizing now as they follow this debate that 
two out of three Americans who are in nursing homes today are supported 
by Medicaid payments. So millions of our fellow Americans who now get 
their care in nursing homes, where Medicaid is providing support for 
two out of three, are going to be put at risk and made vulnerable 
because of this legislation.
  Remember, Donald Trump said he wasn't going to cut Medicaid. This 
cuts it by over $750 billion. Make no mistake, on this issue, this 
Senate bill is a lot meaner than the House bill. We all know that 
President Trump out in the Rose Garden celebrated the passage of the 
House bill. But behind closed doors, what did he call it? Mean. This 
Senate bill, as time goes on, will cut Medicaid far more deeply than 
the House bill. As we look at this Congressional Budget Office report, 
it talks about how you get to the end of year 8 and 9 and 10, and you 
go beyond that. You are going to have very deep cuts, much more 
painful, much meaner than in the Senate bill.
  We have heard a lot about preexisting conditions. The reality is that 
the Senate bill is very devious in this regard. It is a great sleight 
of hand. On the one hand, it creates the impression that if you have 
preexisting conditions, you are going to be all right. But what it 
pretends to give with one hand, it takes away with the other. It makes 
those Americans as vulnerable as they were before the passage of the 
Affordable Care Act.
  I am not talking about those who are directly benefiting, like those 
on expanded Medicaid or those in the exchanges. I am talking about 
those who are benefiting from the patient protections in the Affordable 
Care Act.
  I just got a note the other day from Mark in my State of Maryland 
saying:

       My son was diagnosed with Crohn's disease in 2008, at age 
     18. He was repeatedly denied insurance and was only able to 
     cover part of the cost of care through the Maryland high-risk 
     pool. Obamacare made it possible for him to be insured and 
     care for this lifelong disease.

  It was ObamaCare that ``will literally save his life.'' We have many 
stories like this one from others who were denied access to care 
because of preexisting conditions before the Affordable Care Act.
  There is another major sleight of hand in this Senate Republican 
proposal, and that relates to premiums. I have been listening. We have 
been hearing a lot from our Republican Senate colleagues about how this 
is going to bring down the price of premiums. We all know that what 
Americans care about is what they are having to put out in total for 
their healthcare. There are premiums. How much is the deductible? 
Great, I got a lower premium, but my deductible is now $10,000. There 
are copays.
  Here is the dirty little secret if you dig into the Congressional 
Budget Office report, after listening to many of our Republican 
colleagues talk about premiums. Now, you have to translate a little bit 
here because this is in the budgetese of the Congressional Budget 
Office. What they say on page 9 is this: Some people enrolled in 
nongroup insurance--in other words, in the individual market, the 
people who are currently in the Affordable Care Act exchanges--would 
experience substantial increases in what they would spend on healthcare 
even though benchmark premiums would decline on average in 2020 and 
years later.
  So the translation is that in some cases the premium--that sticker 
price--may go down, but you are going to end up paying a whole lot more 
when it comes to your deductible and your copays.
  It goes on to say that because nongroup insurance--in other words, 
the individual market--would pay for a smaller average share of 
benefits under this legislation, most people purchasing it would have 
higher out-of-pocket spending on healthcare than under current law. It 
goes on and on.
  In other words, keep your eye on the ball, America, because when 
someone tells you your premiums are going to go down, watch what 
happens to all your other healthcare costs. The Congressional Budget 
Office, the nonpartisan analysts, are telling you they are going up.
  This brings me to my final point. I said at the beginning that some 
things get better with time and some things get stinkier and smellier. 
We know that the more the American people get a look at this latest 
Senate Republican proposal--TrumpCare 3.0--the less they are going to 
like it. The more they see it, the more they will hate it. Just like 
something that is rotten gets stinkier with time, this will get worse 
and worse with time. That is why it is so important that we not try to 
jam this through the Senate.

  I understand the Republican leader. He knows this is rotten to its 
core, and he knows the more it sits out there, the more people are 
going to see what it is all about and the more they are going to hate 
it.
  Let's have a full debate, and let's make sure all of us go back to 
our States over the Fourth of July--to the parades, the barbecues, and 
the picnics--and look our constituents in the eye and tell them that we 
are going to take healthcare away from tens of millions of Americans, 
that we are going to open up the discrimination once again to 
preexisting conditions. We are going to increase their overall 
healthcare costs, even though we tell them we are going to be reducing 
them. Let's look them in the eye and tell them what this bill is all 
about rather than trying to push it through in 24 or 48 hours or later 
this week.
  Our constituents deserve to know the facts, and we need to make sure 
we vote to protect the interests of the United States of America, not 
just provide another round of tax breaks to powerful special interests 
and millionaires.
  The PRESIDING OFFICER. The Senator from Hawaii.
  Mr. SCHATZ. Mr. President, you might think that for the last 7 years, 
the major complaint people had about the Affordable Care Act was that 
it hurt rich people, because they seem to be the only people who stand 
to gain with this Republican Senate healthcare plan. They get a giant 
tax break. The rest of America, on the other hand, is in trouble.
  With TrumpCare, healthcare will cost more, and 22 million people are 
going to lose their healthcare altogether. Some healthcare bill. To put 
this in perspective, imagine if everyone lost their healthcare in 
Hawaii, Maine, Nevada, Alaska, West Virginia, Ohio, Idaho, and Wyoming. 
That is what TrumpCare does. That is 22 million Americans. It also 
devastates one of the best healthcare programs this country has.
  With this bill, Medicaid is going to lose nearly $800 billion. If 
your only worry is that your investment income gets taxed at 3.8 
percent every year, you can breathe a sigh of relief. Let me drill down 
on that because one of the most egregious tax breaks in this bill--and 
this is mostly a tax cut bill and not a healthcare bill--is the 
following: If you are making $200,000 as an individual or $250,000 as a 
couple, capital gains income is currently taxed at 3.8 percent. If you 
are making $200,000 as an individual or $250,000 as a couple and you 
have capital gains, not regular income, it is taxed at 3.8 percent. 
This bill zeros that tax out. This bill zeros that tax out. On top of 
that, it is retroactive. Think about the absurdity.
  Here we are. I am looking at the Senator from Pennsylvania and how 
much he has advocated for children and especially for children with 
disabilities. I am looking at the Senator from Connecticut and the work 
he has done for people with chronic diseases and mental health 
challenges and the resources we need for that. And in the middle of a 
supposedly oriented toward healthcare piece of legislation, we are 
giving a retroactive capital gains tax cut to people who make over 
$250,000 a year in combined income. It is absurd. It is not a 
healthcare bill.
  If you have a loved one in a nursing home, if you are pregnant or 
thinking of having a baby, if your kid has a disability that requires 
costly care, if you work two jobs but your employer doesn't provide 
health insurance, then this bill does not take care of you. Instead of 
less taxes, you get less care, and you are going to pay more for it.
  This is what happens when legislators don't have committee hearings 
or they refuse to meet with patients, doctors, nurses, advocates, their 
own constituents. There have been so few townhalls about healthcare. 
There have been so few real Senate debates about healthcare.
  I have seen every single Democratic Member of the Senate come here 
and

[[Page S3771]]

talk about this piece of legislation. I have seen every single 
Republican Member of the Senate talk about legislation that they are 
proud of. I have seen very few people on the Republican side of the 
aisle come down and talk about this bill because they know it is not a 
good piece of legislation.
  At this point, we are not even debating healthcare policy. It is not 
a question of what is the best way to get people to sign up for 
insurance or how we can lower premiums and deductibles or how we can 
improve the delivery system; it is a question of how many people are 
going to lose their healthcare so that insurance company CEOs can 
continue to make millions of dollars a year. That is literally what is 
in this bill. Those are the conversations we are having--nothing 
related to reforming the healthcare system or getting people more 
coverage for less but, rather, tax cuts for people who are involved in 
the healthcare industry.
  How many grandparents are going to get kicked out of nursing homes? 
It is not a rhetorical question. My wife's grandmother was in a nursing 
home 2 months ago. It was a beautiful facility. They took great care of 
her. They had three beds, three nursing home beds. I think the normal 
reimbursement is about $9,000 a month. They took wonderful care of my 
wife's grandmother. They won't exist. That nursing home and all the 
nursing homes like it won't exist if there is an $800 billion cut to 
Medicaid. This is not a theoretical conversation. This isn't even a 
partisan conversation. Everybody has nursing home beds in all of their 
home States. Everybody at least ought to know some middle-class people 
who rely on Medicaid for nursing homes.
  CBO gave us the answer today. Too many people are going to be locked 
out of the healthcare system if this bill goes forward, and all for 
giant tax cuts.
  Look, our healthcare system is not perfect. Changes need to be made, 
but this bill is just not it. It has no clear guiding principle other 
than slashing Medicaid to pay for tax cuts. We have to start over.
  I am looking at the Presiding Officer, who was a speaker of the house 
in North Carolina and understands how to do a bill on a bipartisan 
basis. I am thinking of the numerous Republicans who are capable of 
working on a bipartisan bill that can get 60 votes.
  By the way, the politics would change because if we worked on a bill 
that could get 60 votes, we would be in a wonderful position--the 
Senate is set up to encourage us to work together--because if we abide 
by that 60-vote threshold and we come up with a bill together, we would 
own the American healthcare system together. We don't get to play this 
blame game about what is happening with premiums or what is happening 
with coverage numbers. We actually, on the level, collaborate.
  When you think about a bill or an issue that used to be as partisan 
as public education, we had Lamar Alexander and Patty Murray come 
together. Heck, in the last Congress, we had Jim Inhofe and Barbara 
Boxer do a bill together. It is possible for us to do a bipartisan 
piece of legislation.
  The decision was made to go with reconciliation, and that is 
backfiring because the problem with not involving Democrats is that 
there are Democrats across the country. The problem with not involving 
experts is that you end up with a product you can't defend.
  What we really need to do is take a breath, take the Fourth of July 
weekend, and reconvene as a Congress--not as Democrats and Republicans 
but as Americans who understand that our healthcare system is not 
perfect, that it is in need of improvement, but this bill doesn't get 
it done.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Connecticut.
  Mr. MURPHY. Mr. President, I want to pick up where my colleague from 
Hawaii left off. There is a wonderful analogy that President Obama used 
after the 2016 election. As you could imagine, Democrats were pretty 
dejected the day after, and President Obama put it pretty simply. He 
said: Listen, just remember, these elections are intramural scrimmages. 
We put on temporary pinnies, Republicans and Democrats, but in the end, 
we all belong to the same team. We are all Americans.
  Elections and legislative fights are temporary skirmishes before we 
recognize and realize our greater identity, which is that we have this 
commonality. Clearly, that is not what the American people see here. 
They think our primary identity is our partisan identity, and there is 
a lot of days in which we give them fodder for that belief.
  It really is amazing, when it comes down to it, that when you think 
about the healthcare system, we do have the same goals in mind. There 
are actually lots of other issues on which we don't have the same goal. 
Republicans want to go left, and we want to go right. Republicans want 
to go right, and we want to go left. On healthcare, we actually all 
want to get to the same place: More people have access to health 
insurance, the cost of that insurance is less than it is today, and the 
quality of the care people get is better. It is funny because 
underneath that, it is just mechanics. It is not actually ideology. It 
is a decision as to which lever you press and which you don't.
  I get that a lot of my Republican colleagues don't think we are 
sincere when we say: If you put this monstrosity of a bill aside, we 
will work with you to do something better. But it is sincere. We don't 
want to blow up Medicaid. We are not with you on that. We don't want to 
pass along big tax breaks, only going to the very wealthy. But we get 
that you want some more flexibility for States. We get that you want 
maybe an additional plan offered on the exchanges that doesn't have all 
the bells and whistles the existing plans do. But you get that we want 
stability in the exchanges. We want some certainty in the markets going 
forward.
  There is an important conversation to be had here. Our hope is that, 
with this CBO score, maybe it will be the straw that breaks the camel's 
back, that will cause our Republican colleagues to give up this 
nonsensical approach to healthcare reform and work with us.
  I am going to repeat some of the ground that has already been covered 
here in the next few minutes, but I want to go over some of the 
highlights of this CBO report.
  Senator Schatz previewed this, but it is hard to get your head 
wrapped around what it means for 22 million people to lose insurance.
  This is an old chart from the CBO score on the House bill that held 
that under their approach, 23 million people would lose insurance. I 
X'd that out. We now have 22 million people who would lose insurance 
under the Senate approach. That is the entire combined population of 
Alaska, Delaware, Hawaii, Idaho, Kansas, Maine, Montana, Nebraska, 
Nevada, New Hampshire, New Mexico, North Dakota, West Virginia, and 
South Dakota. All that happened between the House Bill and the Senate 
bill is that the people of Rhode Island got saved. I X'd out Rhode 
Island because Rhode Island has about 1 million people. About 1 million 
more people will have insurance under the Senate bill, but that is 
humanitarian catastrophe. That is a big deal, to have that many people 
lose insurance.
  I know that is not what you set out to do. I know the Republicans 
didn't set out to do this, in part because I listened to Senator Cornyn 
come down and complain on the Senate floor relentlessly that the 
Affordable Care Act still left a whole bunch of people without 
insurance. In fact, he sent out a tweet today highlighting that the CBO 
does confirm that if current law continues, there will still be a lot 
of people without insurance. He left out the fact that the CBO says 
that under the Republican bill, 22 million more people will lose 
insurance, but that is a whole lot of people.
  By the way, in the first year, CBO says 15 million people will lose 
insurance. Fifteen million people is the entire population of 13 
States. That happens next year. Emergency rooms in this country cannot 
in 12 months absorb 15 million people losing insurance.
  For all the folks who say that the ACA is in a death spiral, CBO says 
you are wrong. Very flatly, CBO says that if existing law remains, even 
without any improvements, the number of people without insurance 
effectively remains static. Yes, at the end, if you make no 
improvements, you will go from 26 million people not having insurance 
to 28 million people not having insurance.

[[Page S3772]]

  CBO says--I had to change this because it used to be 51 million under 
the House bill. CBO now says 49 million people will lose insurance if 
you actually pass the bill the Senate is going to consider this week. 
The death spiral happens if we pass the Republican healthcare proposal. 
That is not a death spiral; that is stability. It is not an optimal 
result, 28 million people not having insurance, but it is far 
preferable to 49 million people not having insurance. I understand that 
Republicans will quibble with CBO and say that maybe they didn't get it 
exactly right. Even if they were 50 percent wrong, that is still over 
10 million people losing insurance. By the way, just for good measure, 
CBO was right in their estimates of the percentage of Americans who 
would have insurance under the Affordable Care Act. Inside of their 
estimate--the details worked out differently--but they said that by 
2016, 89 percent of Americans would have health insurance, up from 83 
percent prior to the passage of the Affordable Care Act. Guess how many 
people have health insurance today: 89 percent of Americans, 89 to 90 
percent of Americans.

  We all agree that premiums should go down. If we are going to pass 
something, the result should be that premiums go down. Here is what CBO 
says: Premiums go up and not by a little bit. They go up by 20 percent 
in the first year. Admittedly, I am painting a partial picture here. 
That is 2018. After that, CBO says for certain populations in this 
country, premiums will go down, but it is largely for the young, the 
healthy, and the wealthy.
  CBO says that you will have massive premium increases for older 
Americans. For lower income Americans who are in that age bracket of 50 
to 64, premium increases will go up by at least two times, up to four 
times.
  CBO also says that if you are lower income, you are not going to buy 
insurance because you can't afford it. It doesn't even matter what your 
premiums are because they will be so high, you can't afford them. 
Premiums go up for everybody off the bat--and for lots of vulnerable 
people after that.
  So who gets hurt? Everybody, except for the folks who are getting tax 
cuts. If you are an insurance company, a drug company, or you are super 
rich--maybe that is an unfair term--people making $200,000 or more a 
year get tax cuts, but most of the tax cuts go to the super rich. 
People making over $1 million a year will do fine. If you are an 
insurance company, a drug company, or you are very wealthy, you get a 
great deal out of this piece of legislation, but pretty much everybody 
else gets very badly hurt.
  Today, one of our Republican colleagues said this to a reporter--I 
won't give you a name. One of our Republican Senate colleagues, when he 
was asked about the Republican healthcare proposal, said: ``I am not 
sure what it does. I just know it's better than ObamaCare.'' That is 
about as perfect an encapsulation of the Republican positioning on this 
bill as I can imagine, because if you did know what it did--if my 
Republican colleagues did get deep into the CBO report, it doesn't 
solve a single problem in the American healthcare system. There are big 
problems, such as 26 million people still don't have insurance. This 
bill makes it worse.
  People are paying too much for insurance, especially those folks who 
are making middle incomes who are just outside of qualifying for the 
Medicaid subsidies. This bill makes it worse. Almost every problem is 
made worse by this piece of legislation. I guess that is sort of what a 
lot of Americans wonder--if our Republican colleagues do know what is 
in this bill. ``I am not sure what it does. I just know that it's 
better than ObamaCare.''
  This solves one problem for Republicans. It is a political problem. 
Republicans have said for the last 8 years that they are going to 
repeal the Affordable Care Act. My Republican friends promised it in 
every corner of this country, at every opportunity they had, and this 
does solve that political problem. If you pass this bill, you can 
successfully claim that you have repealed the Affordable Care Act, but 
that is the only problem it solves. It makes almost every other problem 
in this system worse.
  The number of people without insurance goes up. Premiums, especially 
for the poor, the vulnerable, go up. There is nothing in this bill that 
addresses the cost of healthcare, of drugs, of devices, of procedures. 
There is nothing in this bill that talks about the quality of 
healthcare. Every problem--virtually every problem in the healthcare 
system gets worse.
  I will just end by reiterating the offer that Senator Schatz made. I 
think you have a lot of people of very good will who want to work with 
Republicans and are sincere about it. I will be part of whatever group 
gets put together if this bill falls apart this week.
  I held an emergency hearing in New Haven, CT, on Monday, just to try 
to explain to people what was in the Republican Senate proposal and to 
get people's feedback. It was hard to sit through. It was 2\1/2\ hours 
of some really scared folks.
  I will be honest with the Presiding Officer. Most of the people who 
came had disabled kids. Most of the people who came had disabled kids 
who were on or relied on Medicaid, and they were just scared to death 
about what was going to happen to their children. But they also talked 
about the problems that still exist in the healthcare system--the fact 
that drugs are too expensive. Many of them pay too much for healthcare. 
They wanted those problems solved, and they wanted us to work with 
Republicans on it.
  Senator Schatz was right. If we did it together, we would own it 
together. It would stop being a political football. While that would be 
a secondary benefit to the actual good that would come from a 
bipartisan piece of legislation that actually addresses the issues in 
the underlying healthcare system, it would be a pretty remarkable good 
that is possible because we have the same goals in mind. We both want 
the same things. It is just, in the end, putting aside this bill that 
makes all of those problems worse and, instead, sitting down together 
and deciding which levers we want to push to make things better.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Pennsylvania.
  Mr. CASEY. Mr. President, I rise, as well, to talk tonight about the 
issue of healthcare. I thank my colleague from Connecticut for looking 
down the road to when, maybe, we can actually work together on this 
issue. We are in conflict this week, and that is not a place any of us 
want to be.
  We are in conflict because of the elements of this bill. I will make 
two basic points in my remarks tonight, one about Medicaid and then one 
point about another provision in the bill that I think is particularly 
insulting.
  A lot of our discussions start with policy and data, and that is 
important. That is obviously part of the debate about the bill and what 
is in it and what impact it will have on programs and people over a 
long period of time, but part of this debate, of course, is about the 
people we represent. I know the Presiding Officer understands this, and 
I am heartened that he is paying attention to our arguments because 
sometimes--I have done it myself--when you preside, sometimes you are 
doing something else. So we are grateful for his attention.
  I have talked on this floor a couple of times over the last couple of 
weeks--even months--and I will not repeat the stories because they have 
been told a number of times, but Rowan Simpson is a young man whom I 
recently just met. His mom had sent me a letter. Rowan is on the autism 
spectrum, and his mom is very worried about his future because of the 
potential impact on Medicaid and the benefits he is getting today from 
Medicaid.
  I just referred the other day--I guess it was Thursday on the floor--
to a letter from a dad about his son Anthony, who has a number of 
challenges, one of them being that he is on the autism spectrum. I have 
another letter, as well, which I will not go through tonight, but it is 
from a mom in Northeastern Pennsylvania, who wrote to me about two of 
her children--principally, her son who has Type 1 diabetes and what the 
loss of Medicaid coverage will mean for that child, who, in this case, 
is just 4 years old.
  Everyone in this Chamber in both parties has stories like this to 
tell--stories about people who are, because of a disability, totally 
dependent upon Medicaid. That is not unique to one State, and, of 
course, it is not unique to one party.

[[Page S3773]]

  One of the more egregious and objectionable parts of this 140-plus 
page bill is the impact it will have on Medicaid--the Medicaid 
expansion, which many people now know represents probably on the order 
of 11 million people who got healthcare coverage since 2010 and got 
that coverage because Medicaid was expanded. But the bill also speaks 
to the Medicaid Program itself by the so-called per capita cap, capping 
the dollars the Federal Government would provide in the future with 
regard to the Federal-State partnership on Medicaid. These are big 
stakes when it comes to a program that has been with us for 50 years.
  As everyone knows, Medicaid is principally about individuals with 
disabilities, and that is obviously those children I mentioned. It is 
about folks who need some help getting into a nursing home, senior 
citizens. Of course, it is about kids from low-income families who have 
no other healthcare, absent Medicaid. In our State, there happen to be 
1.1 million kids on Medicaid who are from low-income families. The 
disability number in both children and adults is, by one estimate, more 
than 722,000 people. These are big stakes, even if it is just involving 
one of those individuals or hundreds or thousands. But as I will refer 
to later, some of the numbers are, of course, a lot higher than that. 
So those stories and those pleas for help from those families obviously 
do not just inform us, but they inspire us to keep working, to keep 
fighting. I will be fighting against this bill as long as it takes.
  It is likely that we will have a vote this week. I am assuming we 
will, so we have only hours and a few days to fight and point out what 
we believe to be the defects. One of the things that is significant 
about this debate is that we have had people not just writing those 
stories and telling us their story but also telling us and giving us 
ideas about how to conduct the debate and how to fight and how to 
oppose it.
  I have in my hand--I will describe it first before I offer a consent 
request. I have in my hand several pages that list almost 600 names 
from people in Pennsylvania who have written to me over the last number 
of weeks and months, actually. What they are urging me to do is to 
pursue a legislative strategy to protect their healthcare. Why are they 
doing that? It is not because they have nothing else to do. They are 
worried. These people are really worried. They are worried about those 
kids like Rowan and Anthony, whom I just mentioned, and a 4-year-old 
with Type 1 diabetes or a whole long list of other disabilities a lot 
of kids have. They are worried about their parents, who may not be able 
to get the long-term care they need if Medicaid is capped and cut and 
decimated. They are worried about their friends and their families. 
They are, in a word, as worried as anyone has ever been about the 
healthcare of those they love and the healthcare of those they care 
about. That is why they have been writing and going to meetings and 
making phone calls and engaging in such a robust way, all these weeks 
and months.
  Mr. President, I ask unanimous consent that this list of almost 600 
names from Pennsylvanians be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

       Ashley De Padua, Carol Ribner, Lisa Brown, Adam Huard, 
     Julie Strauss, Amy Reynolds, Dianne Spatafore, Pamela Nolan, 
     Karin Fox, Claire Witzleben, Wendy Albertson, Laura Rose, 
     John Mack Jr., Elizabeth Failor, Lisa Bargielski, Peg Welch, 
     Jason Carnahan, Robert Perry, Morgan Vinokurovi, Melissa 
     Byrne.
       Patricia DeWald, Kristin Kondrlik, Michael Crane, Diane 
     Smith-Hoban, Diane Sayre, Benjamin Andrew, Janice Diehl, 
     Robert Bahn, John Bair, Angela McClain, David Cassiday, Dara 
     Bortman, Judi Reiss, Nicholas Marritz, Amber Blaylock, Tina 
     Nightlinger, Lisa Bradshaw, Kimber Schladweiler, Michael 
     Dwyer, Vashti Bandy.
       Christine Russell, Mary Farrington, Ralph Mcdermott, Anna 
     Cunningham, Linette Schreiber, Barbara Powell, Shelley 
     Francies, Joyce Fentross, Shannon Bearman, Jocie Dye, Ina 
     Martin, Mary-jo Tucker, Bracken Babula, David Mosenkis, 
     Martha Franklin, Nathaniel Missildine, Kristin Nielsen, Maria 
     Duca, Erica Bartlett, Irina Pogrebivsky.
       Stephanie Romano, David Hincher, Diane Holland, Tracy 
     Krider, Michelle Nutini, Anne Martin, Tracey Miles, Alexis 
     Lieberman, Dorothy Posh, Thomas Hennessey, Cynthia Mould, 
     Jennifer Kunkle, Ann Calamia, Jennifer Zoga, Barbara Turk, 
     Raymond Hopkins, Carol Proud, Alex Hesten, Kimberly Jones, 
     Richard Pavonarius.
       Robert Huff, Klvdiya Vasylenko, Mike Kass, Bernadette 
     Flinchbaugh, Jo Johnson, Carolyn L. Johnson, Abby 
     Godfrey, Mark Herr, Jeri Sebastian, Lisa Hartjen, Anne 
     Smith, Melissa Nurczynski, Christine Crooke, Ellen 
     Garbuny, Harry Richards, Ruth Hetrick, Carolyn Rahe, 
     Stephanie Moats, Sally McAfee, Abigail Gertner.
       Stacey Smith, Davinica Nemtzow, TC DeAngelis, Shelley 
     Schwartz, Lisa Keppeler, Katie B, Joseph Willard, Maryam 
     Deloffre, Kathie Brown, Ellen Catanese, Cynthia Donahue, 
     Porter Hedge, Gretchen Bond, Mary Dallas, Fae Ehsan, Kathy 
     Goldberg, Jennifer Jarret, Dan Potter, David Dutkowski, Rich 
     DeAngelis.
       Patricia Kay, Sharon Doros, Stephanie Doyle, Lynn Loomis, 
     Elizabeth Adams, Kathryn Petz, Agatha Andrews, Alex Lombardi, 
     Erin Gautsche, Marie Turnbull, Carol Sinclair, Robert 
     Turnbull, Elisa Bermudez, Marie Vincent, Florian Schwarz, 
     Daniel Pencoske, Ina Shea, Beth Collins, Meenakshi Bewtra, 
     Jillian Bosmann.
        Mari Greipp, Michael DiEva, Andrea Epstein, Fredrica 
     Friedman, Starla Crandall, Stanley G., Cindy Fogarty, Ron 
     Ashworth, Trudy Watt,Kristen King, Kathleen Sheehan, Ryan 
     Brown, Kevin Collins, Kelly Collister, Ambry Ward, Joseph 
     Melchiorre, Catherine Abrams, Michael Bourg, Ed Gragert, Hien 
     Lu.
       Jo Johnson, Cody McFarland, Maggie Deptola, Sandra Blair, 
     Zoe Soslow, Yoko Takahashi, Anna Drallios, William 
     Dingfelder, Shawna Knipper, Cheryl Brandt, Larissa Mogano, 
     Linda Bishop, Lital Levy, Laurie Pollack, Judith 
     Navratil, Natalie Duvall, Richard Owens, Elaine Giarusso, 
     David Thomas, Leslie Collier.
       Nicole Seefeldt, Jonathan Lipman, Ellen Gallagher, MaryAnn 
     Black, David Hughes, Michael Niemeyer, Pegene Watts, Kelly 
     Sack, Glynnis Arnold, Ruth Lawson, Michelle LeMenager, Iris 
     Valanti, Danielle Callahan, Frederick Ward, Martha Haines, 
     Audrey Marsh, Lynn Campbell, Kristen Cochran, Judith Brennan, 
     Michael McCabe.
       Joshua Miner, Jaime Bassman, Rachel Murphy, Elena Knickman, 
     Nelson Vecchione, Daniel Laurison, Karen Osilka, Roger 
     Knisely, Theresa Baraldi, Holly Best, Thomas Baraldi, 
     Patricia Walsh, Michelle Herr, Karen Heenan, James Paul 
     Johnson, Alexander Kimball, Sigal Ben, Leah Durand, Ingrid 
     Gustafsson, Mary Jo Maggio.
       Ken Hardis, Lisa DeAngelis, Mary Jo Harris, Alice Ung, 
     Lance Flowers, Deborsh Hoelper, Joel Cardis, Georgine 
     Dongillig, Renee Donahey, Anna Payne, Hallie Kushner, Linda 
     Cortese, Mark Vecchione, Natalie Garner, Rachel Marx, Janet 
     Cavallo, Adrianne Gunter, Heather Turnage, Kenneth Reisman, 
     Flora McGettigan.
       Tricia Connell, Nicole Conley, GiGi Malinchak, Ellen 
     Toplin, Eileen Brumbaugh, Theodore Fallon, Elizabeth Dooley, 
     Stacy Klein, Deena Thornton, Barbara Stephan, Cheryl Dungee, 
     Louisa Alexander, Brett Krasnov, Mary Gallant, Kathy Gardian, 
     Irene Lin, Colleen Dunn, Liane Norman, Susan Yerk, Ann 
     Telford.
       Leslie Elder, Sheri Utain, Christine Hooper, Teri Vanore, 
     Paula Baxter, Mordecai-Marl Mac Low, Nicolette Byer, Donna 
     Vito, Michele Forbes, Rebecca Kane, Katherine Fein, Sue 
     Meyers, Deb Yohman, Sherri Suppa, Jim Greipp, Jeffrey 
     Bussmann, Rachel Smith, Eileen Reed, Louise Beer, Mary 
     Reichart.
       Tesia Barone, Nicole Gilchrist, Richard Greenstein, Amy 
     Levengood, Judith Max, James Walton, Mary Widing, En B, Mary 
     Jo Harris, E. E. Zachai, Tammy Harkness, Timothy McCormick, J 
     Pensiero, Betty Fisher, Cindy Shannon, Elisabeth Whyte, 
     Carmela Daniels, Amy Felton, Judith Gold, Jack Guida.
       Sarah Gaffen, Linda Bullock, Pamela Woldow, Katherine 
     Kurtz, Lisa Harrison, Esther Wyss-Flamm, Catherine Roundy, 
     Jim Barlow, James Schreiber, Dave Carlton, Andrew 
     Famiglietti, Maria Catrambone Rosen, Breanna Jay, Bethany 
     Altieri, Alicia Olivant Fisher, Chris Braak, Jessica 
     Atchison, Elizabeth Dennis, Elizabeth Cates, Elizabeth 
     Reilly.
       James Berry, Marita Scheibe, Sheila Thomas, Randy Sarner, 
     Alyson D'Alessandro, Suann Snavelt, Chantal McKelton, Theresa 
     Glennon, Josie Byzek, Marlene Katz, Deborah Grill, John 
     Moffa, Anne Coles, Liane Norman, Chanda Lawrence, Norma 
     Kline, Colleen Kessler, Maria Catrambone Rosen, Laurence 
     Coles, Kate Wallis.
       Carol Harris-Shapiro, Briana Latta, Melanie B, Charlotte 
     Ridge, Nathan Krisanda, Meredith Sonnen, Margaret Walter, 
     Hallam Carrie, Leslie Richards, Jenny Anne Horst-Martz, Karen 
     Roberson, Richard Vanore, Susan Devenny, Rhana Cassidy, Maria 
     Golden, Kathy O'Brien, Vanessa Baker, Robert Brucicman, 
     Sarah Smith, Yuliya Benina.
       John Ascenzi, Melanie Cichy, Paul Gottlieb, Shannon Browne, 
     Jen Britton, Erin Dunke, Debi Seltzer, Anna Edling, Brianna 
     Wronko, Francis Palombaro, Katie Morrison, Jennifer Hombach, 
     Jessica Lennick, Ellen Toplin, Charlene Kurland, Joanne 
     Mahoney, Sherry Greenawalt, Abigail Hyde, Sara Sierschula, 
     Amy Leddy.
       Emmy S, Renee Broxk, Kimberly Winnick, Melissa Reed, Lisa 
     Jaremka, Karen Shelly-Genther, Melissa Welshko-Williams, 
     Naomi Pliskow, Joan Susski, Rachael Pinsley, Lindsay 
     Friedman, Shari Johnson, Melanie B, Keith Adams, Lynn Martin, 
     Anastasia Frandsen, Brooke Petry, Tamara Davis, Martha 
     Posnet, Phoebe Wood.

[[Page S3774]]

       Lindee Fitting, Isabelle Mahoney, Tamar Granor, Nancy 
     Berman, Karen Jensen, Katie Haurer, Beth Collins, Catherine 
     Budd, Miriam Phillips, Christine Bradley, Michelle Gorski, 
     Chris Gorski, Sophie Taylor, Catherine Borges, Mary Alice 
     Clevenger, Nick Ingram, Brenda Scholtz, Melissa Miller, 
     Jeanne Burd, Nad Rosenbe.
       Joanna Kempner, Maria Boyd, David Shen, Sara Sobel, Jessica 
     White, Jennifer Pennington, Margot Keith, Catherine Sunnen, 
     Naida Reed, Ashley Morgan, Beth Brindle, Amy Friedlander, 
     Millicent Wilson, Richard Baron, Max Ray-Riek, Ruth Cary, 
     Sandy Heisey, Sharon Furlong, Laura Tilger, Donkey Dover.
       Lynn Jones, Kaytee Ray-Riek, Janice Test, Mary Terp, Faith 
     Cotter, Sarah Campbell-Szymanski, Frank Wallace, Judie 
     Howrylak, Minna Ltumey, Erin Hetrick, Melinda Kohn, Jenny 
     Stephens, Susan Gambler, Olivia Landis, Terry Hirst-Hermans, 
     Jill Hall, Roseanne Mulherin, Susan Miller, Julie Platt, Lori 
     Spangler.
       Hiro McNulty, Greg Carey, Amanda Fogarty, Sissy Gault, Mona 
     Callahan, Meryl Mintzer Puller, John Hoetzel, Stacey Kallem, 
     Thomas Paquette, Karen Clark, Paige Wolf, Patricia Scanlon, 
     Ellen Reese, Rosalind Bloom, Gary Stein, Eric Berue, Jenn 
     Hrehocik, Tamara Myers, Mara Kaplan, Amanda Cranney.
       Deborah Miller, Debra Nathans, Paul Stockhausen, Johanna 
     Hollway, Leah Holstein, Susan Robbins, Roger Latham, Alison 
     Yazer, Melissa Marshall, Mary Lynn Colabrese, Harry 
     Mclaughlin, Samantha Payne, Elizabeth Hawkins, Julie Krug, 
     Lisa Heinz, Shoshana Kaplan, Corrine Richter, Lee Baer, Eve 
     Glazier, JoEllen Bitzer.
       Judith Cardamone, Hilary Schenker, Faye Clawson, Caren 
     Leonard, Carol Feldhaus, Judith Moyer, Sharyn Feldman, 
     Jessica Martucci, Mike Kutik, Marylou Streznewski, Ann Baker, 
     Abby Martucci, Dennis Cusin, Marie Norman, Debra Brokenshire, 
     Martha Cornell, Maria Swarts, Sherell Chambers, Suzan Hirsch, 
     Alison Wojtkowiak.
       Patricia Carbone, Marcella Glass, Benjamin Mills, Peg 
     Welch, Rita Shah, Marcia Gever, Karen Phoenix, Tabitha 
     Felton, Carolyn Stillwell, Katherine Parys, Roxanne 
     O'Toole, Harold Love, Nicole Jaffe, Steven Weitzman, 
     Meredith Brown, Lauren Lewis, Sarah Wheeler, Maria Lauro, 
     Jason Magidson Lorette Lefebvre.
       Denise Marcolina, Eric Krewson, Joseph Bosh, Joan Stein, 
     Kami Schaal, Melissa Nerino, Dorothy McFadden, Heather 
     muntean, Donna Devonish, Gloria Rohlfs, Terry McIntyre, 
     Kaitlin Marks-Dubbs, Frederick Page, Douglas Graham, Sarah 
     McKay, Zack Greenstein, Janice Nathan, Michel Wilcox, L 
     Roulston, Laura Wukovitz.
       Andrew Wilson, Amy Moulton, Christina VanSant, Donna 
     Bullard, Nancy Entwisle, Tessa Lamont-Siegel, Ben Cocchiaro, 
     Yasmeen Ali Khan, Rachel Amdur, Amalia Shaltiel, Sara 
     Stetler, Bruce McDowell, Pat Hanahoe-Dosch, Mara Rockliff, 
     Tristan English, Ryan Bross, Lynn Rubenson, Elizabeth Cheney, 
     Regina Vicoli, Vicki Hewitt.
       Kelli Servello, Charles Ang, Kierstyn Piotrowski Zolfo, 
     Leah Bailis, Tom Petersen, Pamela Magidson, Kathleen 
     Morrison, Genevieve Coutroubis, Susan Rubinstein, Ruth Ann 
     Davidson, Frances Winsor, Janis Rainer, Margaret Grubbs, Anna 
     Kuhnreich, Melissa Melan, Wendy Forman, Kristina Witter, Joan 
     Kwortnik.

  Mr. CASEY. Mr. President, I will make two final points about Medicaid 
and then juxtapose Medicaid with another part of the bill. If you look 
at the bill--it is about 140, I guess, 142 pages--more than 60 pages 
deal with Medicaid. So this is principally a bill about Medicaid. There 
are some other issues, obviously, addressed on the exchanges and the 
fundamentals of healthcare. But it is mostly about Medicaid and tax 
cuts, unfortunately; and that is particularly objectionable to me that 
you have a small group of very wealthy people who are going to make out 
in ways we can't even imagine, like a big bonanza for the superrich.

  Now, let me just talk about the Medicaid part of it first, and then I 
will refer to a chart. I am holding in my hand the Congressional Budget 
Office report from today, which came out. It, of course, is a document 
produced by the Congressional Budget Office as well as the Joint 
Committee on Taxation so it is a joint effort.
  On the CBO--so-called CBO Congressional Budget Office report, 
recently--a couple weeks ago now--on page 17 of that document, there 
was an assessment made of the number of people who would lose Medicaid 
as a result of the House bill, and that number was 14 million Americans 
would lose Medicaid over the decade up until 2026.
  Well, unfortunately, as of 4 p.m. or something this afternoon--I 
guess about 4 p.m., 4:30--we got the Congressional Budget Office 
assessment of the Senate bill, the Senate bill that was unveiled last 
week. Not on page 17 of this report but actually on page 16, here is 
what the Congressional Budget Office and the Joint Committee on 
Taxation says about enrollment in Medicaid. I am quoting from the 
bottom of page 16:

       Enrollment in Medicaid would be lower throughout the coming 
     decade, with 15 million fewer Medicaid enrollees by 2026 than 
     projected under current law in CBO's March 2016 baseline.

  Then, they refer to a figure in the report.
  So the House bill CBO assessment says 14 million will lose Medicaid 
coverage. The Senate bill, analyzed by CBO, which is supposed to be a 
more moderate bill, a better bill in the eyes of some Republican 
Members of the House and the Senate, that was supposed to be better, 
but here is what we know now: 15 million people will lose Medicaid. 
That alone should cause any Senator to be very concerned about the 
impact of this legislation. That alone should, I hope, require some 
people to use an old expression: Examine your conscience about what 
will happen if you vote for this legislation.
  Let's say someone says: Do you know what? I can put that into 
context, and I think actually that will not happen or I have another 
explanation or whatever justification or rationale you use for voting 
for a bill that will result in 15 million people losing Medicaid 
coverage. People are very vulnerable. Let's just say you can analyze 
that a different way and come to a different conclusion. We will see 
how people deal with that number this week when they go home and when 
they have to talk about this legislation over time.
  Here is where it gets a lot worse. This is a chart that is rather 
simple. Even though it has a lot of data on it, it is rather simple. 
Here is what it says at the top. First of all, this isn't my chart; it 
is the Center on Budget and Policy Priorities' chart. You can go to 
cbpp.org to see it.
  This is based upon the House bill, but I just told you that the 
Medicaid enrollment number is 1 million higher--or that the number 
losing Medicaid is 1 million higher under the Senate bill, and the tax 
cuts that are in the Senate bill are almost identical. You can just go 
down and count them. The House and Senate bill are virtually identical 
on tax cuts.
  Here is what the headline is: Tax cuts for the top 400 roughly equal 
to Federal spending cuts from ending Medicaid expansion.
  Now, remember, I said before that Medicaid expansion is one problem I 
see. The per capita cap is another. This chart just deals with one of 
the Medicaid problems--Medicaid expansion--so ending Medicaid expansion 
in Nevada, West Virginia, Arkansas, and Alaska, just four States, 
right? Alaska, they project, will lose $2 billion worth of Medicaid 
over the decade, Arkansas would lose $7 billion, West Virginia would 
lose $12 billion, and Nevada would lose $12 billion. That adds up to 
$33 billion Federal Medicaid cuts from ending Medicaid expansion. So 
$33 billion dollars just for States. By the way, these are not really 
high-population States. There is no California, New York, Texas or big 
States like that. So $33 billion lost in Medicaid in just those four 
States.
  What does this orange bar graph show? The same number, $33 billion 
tax cut for the 400 highest income households in the country. It is the 
same number. So 400 households get a tax cut of $33 billion, not in 
some other bill down the road, not in some other year, not in a budget 
bill or a tax bill. They get this massive tax cut in what is called a 
healthcare bill. At the same time, it is equivalent to the total 
Medicaid lost in just four States.
  It gets worse if you add more States. Guess what. If you add up about 
30 States in a different chart, it is about the same as all the tax 
cuts together, but here we are just talking about four States and 400 
families.
  I hope I am not offending anyone if they are in those top 400 
households who are making either billions or, by one estimate, the 
average might be $300 million. I know it has been difficult to make 
ends meet. You have been struggling and trying to pay the mortgage and 
the light bill when you are one of the top 400 richest households in 
the country.
  But this chart, when you juxtapose this chart--and especially the 
orange part, the tax cut for 400 families, the giveaway to families who 
don't need it. Frankly, they don't even want this tax cut. I haven't 
found one person who came up to me in the last couple of years and 
said: You know what, I wish my taxes didn't go up. I wish those

[[Page S3775]]

taxes didn't go up while you were trying to help people on Medicaid. 
Not a single person said that.
  Most people who will get this tax cut would rather that we make sure 
we take care of those children I mentioned with the disability or those 
families who need the protection of Medicaid.
  When you put this chart next to the policy and those 60-plus pages of 
the decimation of Medicaid, there are a lot of words we could use that 
we are not allowed to use on this floor, but one of the words we should 
use is ``obscene.'' That is an obscenity. When you match these cuts for 
400 families next to the cuts to Medicaid, that is obscene, obnoxious, 
and bad policy.
  If there was ever a reason to take this 142-page bill and throw it in 
the trash, throw it in a garbage pail as fast as we can, it would be 
this chart because that is not what the American people are asking for. 
They actually think some people in the Senate are actually working on a 
healthcare bill. That is what they believe. A lot of people don't know 
about this yet, but they are going to know. They are going to know by 
the end of the week, at least, if not sooner, that the 400 richest 
households in the country are getting that much money--$33 billion. 
Maybe in the Senate bill it is only $32 billion or $31 billion, so we 
will stand corrected if it goes down, but that is really an 
abomination. That is an insult to the American people. People should be 
ashamed this is part of that bill.
  I get it. We can have a debate about Medicaid. I get that, but when 
you are taking Medicaid dollars and transferring to wealthy people, no 
one should support that kind of a policy, but that is what we have. 
That is what we are up against.
  If there was ever a reason to fight to the ends of the Earth against 
a piece of legislation, it is this. We are going to continue to fight 
this. We are going to continue to point out this basic inequity, this 
insult for the rest of this week.
  We hope folks on both sides of the aisle will not only be listening, 
but we hope our Republican friends will take another look at this bill 
and understand how objectionable this is to so many American families. 
All of that worry I talked about before is made worse, is aggravated by 
this kind of result when it comes to tax cuts.
  We can do all that as a great nation. We can make sure wealthy folks 
who need a break once in a while--they have gotten a lot of them in the 
last 25 years--that they can get a fair tax code. We could also make 
sure kids with disabilities, seniors, and kids in rural areas and big 
cities and small towns can get the healthcare they need from Medicaid. 
We are a great country. We can do that. We can have a growing economy 
and still support a critically important program like Medicaid.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Massachusetts.
  Ms. WARREN. Mr. President, we have just gotten the latest numbers on 
the Senate Republicans' reckless plan to take away health insurance 
from millions of American families, take it away from sick, little 
kids, take it away from seniors in nursing homes. These numbers are 
worse than anyone expected.
  After weeks of secret work behind closed doors, the Republicans came 
up with a plan that will take away health insurance from 22 million 
people and slash the Medicaid Program by nearly $800 billion, all in 
exchange for shoveling hundreds of billions of dollars of tax cuts to 
the richest families in this country.
  You know, with results like these, Senate Republicans should not 
still be trying to figure out the best way to ram this bill through the 
Senate. They should just throw it in the trash.
  We don't have a lot of time left, and I know it is easy to tune out 
these debates and to assume these are all just a bunch of partisan 
games. So if you aren't inclined to take my word for it, don't, and 
don't take the Republicans' word for it either. Take a look at what the 
experts are saying about the Republican bill because since this brutal 
bill was finally revealed on Thursday, it has been denounced by 
nonpartisan doctors groups, health policy experts, and patient 
organizations. The American Medical Association says the bill violates 
the fundamental principle of medicine: ``First, do no harm.'' The 
Children's Hospital Association says it is ``a major step backward for 
children and their health.'' The National Council for Behavioral Health 
says, ``Instead of `repeal and replace,' it is `wreck and wreak 
havoc.'''
  Lynn Nicholas, the head of the Massachusetts Health and Hospital 
Association, has actually come up with a pretty simple test for the 
Republican plan: ``I challenge any Republican Senator to name one thing 
in this bill that will make healthcare in the U.S. better for patients 
or healthcare professionals who care for them.''
  Think about that. She says use that as the test, one thing. That is a 
pretty low bar--one thing. Yet the Republicans can't pass that test. 
They can't name one thing in this bill that will improve healthcare in 
America. That is because this bill is not supposed to improve 
healthcare in America. It is not a healthcare bill. It is a tax cut for 
the rich, paid for by gutting healthcare for millions of working 
Americans.
  Doctors, patients, parents, families, experts, they are terrified by 
this bill because they have read it, and they have concluded that 
nearly every line in this bill would make life worse for young people 
and for old people and for families across this country.
  I want to focus on just one major part tonight, the part that rips 
away the Medicaid Program. Let's do some basic Medicaid facts. Who uses 
Medicaid? Thirty million kids. That is about 4 out of every 10 kids in 
this country count on Medicaid to help pay the medical bills. About 6 
out of 10 children with complex medical needs--children who need 
breathing tubes, special therapies, and multiple surgeries, 6 out of 10 
of those children count on Medicaid to help pay their medical bills. 
Nearly two out of three seniors in nursing homes count on Medicaid to 
help pay their bills, and one out of every three people dealing with 
addiction counts on Medicaid to help pay for treatment.
  Who uses Medicaid? America uses Medicaid--children, the elderly, 
hard-working families, people with disabilities, and people struggling 
with addiction. At any given moment in this country, one in every five 
Americans is counting on Medicaid to help pay the bills. What are these 
people supposed to do when the Medicaid expansion goes away, when this 
bill's additional massive Medicaid cuts go into effect? What are they 
supposed to do? What are their families supposed to do?
  Dig in on one issue around this. Dig in on opioid abuse. This is a 
problem that is growing around the country. Last year we lost 2,000 
people in Massachusetts alone. I hear from parents who have lost 
children, from brothers and sisters who have watched a loved one 
disappear. I hear from people who are desperate because their child or 
sister or brother can't get into a treatment facility. I hear from 
dedicated doctors, nurses, and counselors who need more resources so 
they can expand treatment programs. Now the Republicans propose a bill 
that is like throwing gasoline on a bonfire. One in three people 
struggling with an addiction are counting on Medicaid, and the 
Republicans plan to cut nearly $1 trillion from the program. I do not 
understand. I cannot understand how the Republicans could turn their 
backs on literally millions of people who need help.
  The cuts to Medicaid are terrible, but there is more. The Republican 
bill also slashes the tax credits that people use to help pay for 
insurance. The budget nerds at the Congressional Budget Office say that 
``most people'' would ``have higher out of pocket spending on 
healthcare than under current law.''
  Think about that. Under the Republican plan, healthcare costs will go 
up for most people, and even if someone can manage, somehow, to afford 
coverage under the Republican bill, the Republicans are willing to let 
insurance companies drop expensive benefits that the companies just 
don't want to cover, including--are you ready?--opioid treatment. If 
this bill passes, it will devastate our ability to fight opioid 
overdoses. This isn't a hypothetical. This isn't speculation. Before 
the Affordable Care Act became law, one-third of individual market 
health plans didn't cover substance use disorder services, and about 
one in five plans didn't cover mental health services. The insurance 
companies don't want to cover these services, but the ACA made coverage 
mandatory. That

[[Page S3776]]

meant that no one in this country had to wonder when they showed up at 
a clinic whether or not their insurance would help them out, but the 
Republican bill opens the door to dropping those requirements. Millions 
more people could be left out in the cold at a time when they most need 
help. This is cruel. Our country is already struggling with a treatment 
gap, and far too many patients facing addiction can't get the care they 
need. The last thing we should be doing is kicking millions of these 
patients off of the coverage they already have.
  Now, let's face it. The Republicans realized this, and they have a 
plan on this issue. They know that what they are doing is indefensible. 
So they have a plan. They propose to throw $2 billion into a special 
fund for opioid treatment and say: Problem solved. This is political 
spin at its worst.
  For every dollar the Republicans propose to put into opioid 
treatment, they are taking out more than $100 from Medicaid, the rock 
on which our ability to provide opioid addiction treatment is built. 
Why? Why treat our brothers and sisters, our children, our elderly 
parents so shamefully? Why? So that Republicans can produce a giant tax 
cut for a handful of millionaires and billionaires. That is it. Our 
friends, our families, and our kids can struggle on their own. They can 
die on their own so that Republicans can cut taxes for the richest 
people in this country.
  What the Republicans propose is morally wrong. It is not too late to 
do the right thing. It is not too late to reverse course. It is not too 
late to junk this bill and start over. I hope the Senate Republicans 
have the courage to do exactly that.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Rounds). The Senator from Colorado.
  Mr. BENNET. Thank you, Mr. President.
  I appreciate very much the comments from my colleague from 
Massachusetts and my colleague from Pennsylvania.
  I notice my colleagues from the other side of the aisle are not here 
tonight to defend this piece of legislation. It doesn't surprise me, 
given what is in this legislation and given what we have heard over the 
last week.
  The Senator from Massachusetts was explaining what it was we were 
trying to do when we passed the Affordable Care Act, now years ago. 
Part of what we were trying to do was to extend coverage to a lot of 
Americans that didn't have it. In my State of Colorado that meant over 
600,000 Coloradans who didn't have it before the Affordable Care Act 
was passed. Another thing we were trying to do was to say to insurance 
companies that it is not OK to have as your business practice that you 
take month after month after month of premiums from people and then 
when they call on the phone and say: My kid was sick; my kid got struck 
by lightning; my kid had an accident, to then hold them on the phone as 
long as possible just as a way of denying their claim. Most people in 
America are too busy trying to move their family ahead, trying to get 
by, to stay on the phone all day with an insurance company. While we 
were at that, we said: It is not fair to deny people insurance in the 
richest country in the world because they have preexisting conditions. 
It is not fair that it is a business plan in America to have lifetime 
caps on people in the richest country in the world who might hit those 
lifetime caps because they get cancer. It is not fair that in America, 
the richest country in the world, some seniors have to cut their 
medicines in half every month just to get through the month and to pay 
their bills. These were some of the issues that we were trying to 
address when we passed the Affordable Care Act.
  Mr. President, I am from a Western State, like you. I was out all 
those months in Colorado, having town hall after town hall, not just in 
Democratic parts of the State but in Republican parts of the State, 
trying to explain what it was we were trying to do--both to give people 
better coverage, more predictable coverage, and less costly coverage 
and also to try to do something to bring down healthcare costs in this 
country. We succeeded at some of those things. We didn't succeed at 
others of those things. It was a legitimate attempt at trying to 
deliver something for the American people that people all over the 
industrialized world don't have to live with.
  Only in this country do people have to make choices about feeding 
their family and taking care of their kids at the doctor. Only in this 
country do seniors have to make choices about cutting those pills in 
half. Only in this country do people have to make choices about paying 
their rent and taking care of their kids. It doesn't happen in the rest 
of the industrialized world. Before I hear it from the other side 
tonight, let me say: Our results are getting worse, not better. For 
populations across this country, longevity is actually getting shorter, 
not longer. This is a difficult, complex, but urgent question for our 
country.
  That is what we were trying to do with the Affordable Care Act. Some 
of it succeeded and some of it didn't. I will talk more about that in a 
minute.
  For 8 years Republicans ran for election after election after 
election on ObamaCare: ObamaCare is socialism; ObamaCare is a Bolshevik 
plot to take over the United States; ObamaCare is destroying jobs--just 
at a time when we were coming out of the worst recession since the 
Great Depression. We saw uneven job growth in this country but 
undeniable job growth over the entire period of time they were saying 
ObamaCare was destroying the country and destroying our economy.
  The recession was at the end of the last administration. The Obama 
administration saw the largest job increases we have seen in this 
country since World War II. I know it is inconvenient to believe that 
or to say that. I know that in corners of the internet where false news 
really does dominate, people don't believe it, but it is true. I am the 
first to say there are not enough good jobs, and I am the first to say 
there are not enough high-paying jobs, but compared to the record we 
inherited, it was a success, all while we had the Affordable Care Act 
being implemented, all while we were extending coverage to millions of 
people in America--many of them children who didn't have adequate 
coverage before we passed the Affordable Care Act.
  It has been called every name in the book, just like President Obama 
was called every name in the book, and they linked those two things--
healthcare reform, the Affordable Care Act, and ObamaCare. That became 
its name.
  Every single attack under the sun was levied on that. Why? Because 
people really believed it was destroying the healthcare system? Maybe 
some people did. Because they believed that it was destroying 
businesses? Maybe some people did. I suspect there was a much more 
simple reason, and that was to try to win elections.
  By the way, while we are on the subject, no matter whether you 
support the Affordable Care Act--and I support some things about it; 
there are other parts of it that have been disappointing to me--I think 
it is fundamentally important for people to understand that the 
Affordable Care Act is not our healthcare system. It is part of our 
healthcare system. The regulations that it has placed on insurance 
providers so that people with preexisting conditions couldn't be denied 
insurance is part of our system. The fact that it tried to create 
accountable care organizations so people got better primary care so we 
would reduce the amount of hospital readmissions from something like 18 
percent or 19 percent, which wasted billions of dollars in this 
country, down to 2 percent or 3 percent, that is healthcare.
  But there is a lot of healthcare that has nothing to do with 
ObamaCare or that has something to do with it but it was not the 
creation of ObamaCare. There is Medicare and Medicaid. There are 
doctors. There are nurses. There are patients. There are drug 
companies. That is our healthcare system, and our healthcare system is 
a mess. It is a mess. It is a mess. We tried to take this thing and 
improve it when we passed the Affordable Care Act. Some of it worked; 
some of it didn't work. Some people would argue we went too far. Some 
people would say we didn't go enough.
  But I can state this. I have been doing those town halls again in 
Colorado, and what I know is that people feel defeated not by ObamaCare 
but by the American healthcare system--by our healthcare system, which 
is less predictable and less affordable than in many countries around 
the world.

[[Page S3777]]

  Now President Trump knew this. He is a smart politician. I never 
thought he was going to win. I never thought he was going to win on a 
campaign that on so many dimensions was out of step with conventional 
American political thought, and I was wrong. He won. I don't think he 
represents a traditional Republican view, and that may be one reason he 
won. In no sense do I think of Donald Trump as a conservative. I think 
of him as quite radical in his proposals. I think of him as a 
reactionary force on a political system that the American people, for 
whatever reason--some of them are probably good reasons--were losing 
their patience with.
  You cannot deny that the guy, somehow, in the far reaches of Trump 
Tower, had his finger on the pulse of what was going on in some parts 
of this country. I don't know if it was because he was a reality TV 
star or what it was, but one of those things was healthcare. He 
understood the American people's dissatisfaction with our healthcare 
system, just as these 7 years and 8 years of Republican campaigns have 
understood it. Majority Leader McConnell made it clear when we were 
passing the bill: You own it. You own it. He said in a book later that 
it was very important to him that the American people were able to 
demarcate between the Democrats' responsibility for the healthcare 
system as it was and the Republicans' willingness to take no 
responsibility for it.
  Even though we had hundreds of hours of hearings that lasted more 
than a year and even though we had--they are not countless--well over 
100 Republican amendments that were made in committee and on the floor 
that were incorporated in the legislation, in the end, not a single 
Republican voted for the bill.
  Maybe that was a principled reason, not just a political reason, 
because maybe there are some people who have the view in the Republican 
Party that the Federal Government should not have any increased 
involvement in their healthcare system. In fact, I have heard some 
people say the Federal Government should play no role in the healthcare 
system. Yet whatever the reason, not a single Republican voted for 
ObamaCare.
  The rest of the history writes itself, which is that every premium 
increase in America, whether it was related to ObamaCare or not, 
becomes part of ObamaCare. Every drug that gets increased in price 
becomes ObamaCare, and for everybody who loses his insurance, that is 
ObamaCare when what is happening is really far more complex than that.
  There are very legitimate critiques of ObamaCare, but it is not the 
same thing as our entire healthcare system. I think it is important to 
make that point because, whether we are considering the Republicans' 
proposed bill tonight or someone else's proposed bill tonight, we would 
have to understand it was not going to fix the whole problem all at 
once.
  People in my State are deeply dissatisfied with our healthcare 
system. I say that as somebody who voted for the Affordable Care Act. I 
have said it before. People have tried to make a political issue out of 
it. They write ads about it: Look, Bennet said the healthcare system is 
not perfect.
  I will go further than that. It is a crying shame that people in this 
country have to spend their lives wrestling with insurance companies, 
lying awake, wondering whether their kids are going to be able to get 
primary care or dental care or cancer care if they get sick. That keeps 
families up every night in my State, not so much the people who are on 
Medicare but a lot of other people.
  So Candidate Trump saw this unease in the American people, this 
concern that the American people had with our healthcare system, which 
I share, and in his campaign--in his very populist campaign for 
President--he promised to provide ``such great healthcare at a tiny 
fraction of the cost.'' Those knuckleheads in Washington do not know 
what they are doing. I am going to deliver you ``such great healthcare 
at a tiny fraction of the cost.'' That was his promise to the American 
people. That is what he said he was going to deliver.
  He differentiated himself from other Republicans by saying: ``I will 
never cut Medicare.'' ``I will never cut Medicaid.'' He said: Those 
other Republicans say they will. I am not going to do that, but I am 
going to supply better healthcare than you are getting now at a tiny 
fraction of the cost. He said: ``Everybody is going to be taken care of 
much better than they're taken care of now'' with no cuts to Medicare 
and no cuts to Medicaid.
  We had our election, and people voted for this nominee who made not 
just these promises but many other promises about what he was going to 
do for our economy based on, I think, largely, a complete fiction about 
what is actually going on in our country--for that matter, in the 
world--with respect to our economy. So he won. He did not just win--the 
Senate is Republican, and the House of Representatives is Republican.
  Now, after running elections for 8 years to get rid of that scourge 
on America, that stain on America, that legislation that has destroyed 
our economy and destroyed our healthcare system, they wrote a bill. It 
took them a long time, really, to get it through the House of 
Representatives, which was shocking, because they had 8 years to figure 
out what was wrong with the current system and how to address the 
current system. They tried it once, and they could not even bring it to 
a vote in the House. They could not even bring it to a vote.
  Then, understandably, the people who sent those Republicans to office 
in the House said: What are you talking about? You said you were going 
to repeal ObamaCare. You told us all of these terrible things that 
ObamaCare had done. Your first order of business was to repeal 
ObamaCare. How dare you not have a vote?
  I am glad they said that because people should keep their promises.
  I have believed for a long time that people want consistency out of 
their politicians, that they will put up with inconsistency if you say 
to them that the facts are different than I thought they were and that 
is why I changed my view. Yet, in these times of fake news, of the 
media having the challenges it has, and the rest of the things that ail 
our system, consistency is not something that a lot of politicians pay 
attention to. I think they think that is because voters do not pay 
attention to it, but, in this case, they did. They said: You said you 
would repeal ObamaCare. You did not just say it once. You said it year, 
after year, after year, after year. Finally, they then passed a bill in 
the House. Not a single Democrat voted for it.

  We learned from that process, which took place before the 
Congressional Budget Office had even scored the bill--imagine that. 
There were all of these people who criticized the Affordable Care Act, 
and proponents were rushing the bill through. As I said, I think there 
were 200 Republican amendments adopted. It was a bill that held almost 
countless committee hearings in the Senate Finance Committee and the 
Senate HELP Committee. It was a bill that consumed 25 days of 
legislative process on this floor, a modern record in terms of time. In 
fact, we had all of that process, and I will come back to this.
  Here is what Senator McConnell said about that. After all of that 
process, he said on this floor, I think, that Americans were ``tired of 
giant bills negotiated in secret and then rammed through on a party-
line vote in the middle of the night.'' Oh, that bill was negotiated 
completely in public, painfully in public. I used to go home, and 
people in my townhalls literally had copies of the bill. Do you 
remember the chant: ``Read the bill. Read the bill''? That is because 
everybody had the bill.
  On the House side, it is important for people to understand that they 
passed the bill without even getting a score from what is called the 
Congressional Budget Office. The head of the Congressional Budget 
Office is appointed by Republicans when the Republicans are in the 
majority, not by the Democrats. It did not even get a score. We had a 
score on the Affordable Care Act before we passed the bill. We had a 
score that every single American could see about what it would cost and 
what money it would spend, what money it would save, how many people 
would be added to the insurance rolls. We had that. They did not have 
the decency to do that in the House.
  They should have because--guess what happened--when the score came 
out, it said that 24 million people would lose their health insurance 
after

[[Page S3778]]

a candidate for President said that you are going to have ``such great 
healthcare at a tiny fraction of the cost.'' ``Everybody is going to be 
taken care of much better than they're taken care of now,'' unless you 
are one of those 24 million and, I would argue, many of the rest as 
well. I will come to that.
  So they passed that bill, a terrible bill. I think that bill has the 
lowest approval rating among the American people of any piece of 
legislation that has existed in the time I have been in the Senate. It 
is still not as low as the approval rating of this place, which used to 
be 9 percent, but it is low because people know it does not really 
address their healthcare problems. It is not a healthcare bill.
  Then the President found out what was in the Congressional Budget 
Office's score, and he had some Republican Senators over to the White 
House and said: I hope you will not pass a bill like that. That is a 
mean bill.
  That is not my description. That is President Trump's description of 
the House bill. That is a mean bill.
  He said: I want a bill with a little more love in it than that bill 
out of the Senate.
  He has to be disappointed tonight because the Congressional Budget 
Office's score came back and said that under the Senate's version of 
the bill--the less mean bill--only 22 million people will lose their 
health insurance and that far from having better insurance at a lower 
price, half of the country--literally half the country--is going to pay 
thousands more in out-of-pocket expenses because of what has become 
known as TrumpCare.
  There are three principal parts to the bill in the Senate and in the 
bill that has passed the House. There are some differences, but I would 
say they are differences without a distinction. They are immaterial 
distinctions. There are three major components to these so-called 
healthcare bills.
  The first is a massive tax cut for the wealthiest people in America. 
If you are making $200,000 or less in Colorado or in any State in the 
country, you will not get a penny from this tax cut--not a penny. As my 
colleague from Pennsylvania said, if you are one of the top 400 
taxpayers in America, together, you are going to get $33 billion in tax 
cuts. That is an average tax cut for each of those 400 Americans of 
$82.5 million. There is not a person in Colorado at any one of my 
townhalls who has said to me: Michael, the key to doing a better job 
with our healthcare and the key to fixing ObamaCare--and I am talking 
about the critics of ObamaCare. There is not a one who has said to 
repeal those taxes on the top 1 percent of taxpayers in America at a 
time when our income inequality has not been greater than in 1928 and 
at a time when we are collecting in revenue only 18 percent of our 
gross domestic product and spending 21 percent. Not a single person has 
stood up in a townhall meeting and said the key to success here is in 
cutting those taxes. Just to be clear, I should mention that $82.5 
million is over a 10-year period. It is about $8.25 million a year.
  As Senator Casey, from Pennsylvania, noted, that $33 billion adds up 
to be the equivalent of what it would cost to pay for the Medicaid of 
772,000 people who live in just four States--the entire Medicaid 
population of four States.
  But what they would consume in healthcare to try to support 
themselves and their family is not $8.5 million a year; it is not $85 
million over 10 years; it is, on average, $4,500 a year on healthcare. 
That is the first part of this bill--a massive tax cut that is not 
going to benefit anybody in my State who earns below $200,000.
  The second element of this bill is a massive cut to Medicaid, which 
is one of the fundamental safety net programs in this country. The cut, 
whether you look at the House cut or the Senate cut, is massive. It is 
about a quarter of the program. It is about $840 billion. And in the 
Senate bill, the cuts are even deeper than they were in the House bill. 
I wonder what the President would say about that. The House bill was 
mean. I bet he would say the Senate bill is cruel because it 
perpetuates those cuts.
  I have heard the rhetoric from politicians in Washington about why it 
is so important to cut Medicaid. They need to cut Medicaid so they can 
pay for the tax cuts for people who are so wealthy, most of them 
probably don't even need to mess around with insurance to pay for their 
healthcare or their doctors. Now they are going to have another $8.5 
billion a year. Now they are going to have another $85 million over 10 
years if they want to spend it not on insurance but on whatever else 
they want to spend it.
  So on the one hand, they had to find the money to pay for this tax 
cut. They found it from some of the poorest Americans there are. How do 
they justify that? They justify it by painting a picture that says that 
there are Medicaid recipients all over America who are receiving 
Medicaid but not working, and therefore we should cut the program 
because if we cut the program, they will know they have to get a job in 
order to buy health insurance, and they won't be on the Federal 
Medicaid Program. They say to go to work, and that is why we can cut 
this program. Keep people out of that hammock they are lying in instead 
of working for their healthcare.
  What an insult to the almost 50 percent of Medicaid beneficiaries in 
Colorado who are poor children. Are they supposed to go to work, or can 
they go to school? And while we are at it, maybe we should think about 
giving them better schools so they can actually compete in this 
economy. But are we really going to take away their healthcare?
  Then there are a whole bunch of people who have spent down their life 
savings for the privilege of being in a nursing home paid for by 
Medicaid. There is not a townhall I have where there aren't sons and 
daughters or grandsons and granddaughters of people who are in nursing 
homes paid for by Medicaid after they had to spend their whole life 
savings down to be there. What a terrible system it is that a family 
has to be near bankruptcy before we say: We will give you a helping 
hand. It is a terrible system, but it is what they have. And they can't 
work. They are in a nursing home. They are in long-term care.
  Then there are a whole bunch of people in my State and in other 
States--and this may be the greatest insult of all--who are working at 
one job or sometimes at two jobs, and in the richest country in the 
world, they are working and are getting paid and are not getting paid 
enough to be off the Medicaid rolls. They are working, and they are 
still on public assistance. And we are cutting a quarter of the 
Medicaid Program because people need to go to work.
  I am not making this stuff up. I asked Secretary Price, who is the 
Secretary of HHS, Health and Human Services--he is in charge of the 
healthcare for this administration--I said: Mr. Secretary, let me take 
you through the faces of the people in my State who are on Medicaid. 
And not only did they confirm that that is who is on Medicaid in my 
State, he said that is the way it looks all over the country.
  What an insult to justify a massive tax cut for the richest Americans 
by taking away poor people's healthcare; by saying they are not working 
for it, when they are children, when they are in nursing homes, when 
they are working one and sometimes two jobs in the richest country on 
the world.
  So that is the second part of this healthcare plan--tax cuts for 
wealthy people and cutting Medicaid for poor people. And in the middle 
of that is the only thing that could fairly be described as a 
healthcare plan; it is just a terrible plan.
  Senator Paul from Kentucky--one of the more principled people in this 
Chamber--said it very well when he called it, not politely, ``ObamaCare 
lite.'' He is absolutely right. If you hate ObamaCare, you are really 
going to hate ObamaCare lite. It is the same structure, which amazes me 
because all of the people who said we should repeal ObamaCare are now 
preserving the very basic structure of how the program worked, but the 
problem with it is that they have cut the subsidies. They have turned 
them into tax credits and cut the value of the subsidies. If you think 
insurance is expensive now in the individual market, wait until you 
meet ObamaCare lite, in the words of Rand Paul.
  So those are the three components of the bill. And it is not 
surprising to me that for those reasons, Senator McConnell has written 
this bill in secret. It

[[Page S3779]]

is not surprising to me that he hasn't wanted to have a committee 
hearing. It is not surprising to me that he brought the bill here on 
the floor last Thursday, then accused people on the other side of not 
having read the bill and still wants us to act on the bill this 
Thursday so he can go home before July 4th and say to the American 
people: We did it. We kept our promise. We repealed ObamaCare. We may 
have written a terrible piece of legislation that has nothing to do 
with improving your healthcare, but we repealed ObamaCare. And he is 
hoping the American people won't notice.
  Let me tell you something. The American people are noticing. There is 
a reason why the House bill has the worst approval rating of any piece 
of legislation in modern American history. The American people are not 
stupid.
  I was in Frisco, CO, not that long ago, which is a place that 
everybody should visit from all over the country. There is tremendous 
skiing, and there is tremendous hiking, wonderful people. And before I 
had the townhall meeting, I went and visited a healthcare center there 
that they are justifiably proud of. It turns no one away. It gives 
phenomenal primary care. It gives phenomenal dental care. They have to 
figure out every week how to get through, but they always figure out 
how to get through so that people in Frisco and in the surrounding area 
have healthcare.
  This is not a poor community by American standards. It is a resort 
community, but there are people who live there year-round. I asked the 
people who run the clinic: Who are the payers for healthcare in your 
clinic? Who are they? What pays for healthcare here? And she said: 
Well, Michael, the Medicaid is 33 percent. That shocked me because if 
you are in rural Colorado, the Medicaid number is usually a lot higher 
than that because people don't have access to a lot of resources, and 
we all know they don't have access to a robust insurance market. 
Thirty-three percent was Medicaid, 53 percent was uncompensated care, 
and the rest was private insurance companies that pay for the 
insurance. That shocked me.
  I said: Fifty-three percent is uncompensated care, people with no 
insurance? How can that be?
  She said: These are people in our community who make too much money 
to be eligible for Medicaid, but they can't afford private insurance.
  They are working full time; that is not the problem. They are not 
even--as I described before in a case where somebody is paying them too 
little, so they are eligible for Medicaid; their problem is that they 
are being paid too much, and they are not eligible for Medicaid as a 
result, but they can't afford private insurance. I think that is an 
indictment of the Affordable Care Act that I accept as somebody who 
voted for it. The idea that we would require people in America to buy 
health insurance and then not have a market that gave them quality 
health insurance at an affordable price is ridiculous.
  I have had people in rural Colorado say to me: Michael, look, why are 
you requiring me to buy something where there is not enough 
competition, so the premium is high and the deductible is ridiculous. 
So it is of no use to my family, and you are requiring me to buy 
something that is useless to me. We should have more competition to 
drive down price.
  I say: You are 100 percent correct.
  And if we had a functioning Congress that wanted to take a bipartisan 
approach to fixing that problem, we could fix it, and there are 
probably 15 or 20 other things along those lines. But the Republican 
healthcare bill--so-called healthcare bill--does none of that. It does 
none of that.
  So to the extent that you don't like ObamaCare because you feel as 
though your premiums are going up and you are not getting enough for 
it, as opposed to the millions of people who have gotten insurance as a 
result of it, some for the first time--to the extent you are worried 
about that, the House bill makes it worse and the Senate bill makes it 
worse.
  There is a projection in the CBO report that says that at a certain 
point in time, your premiums might come down under the Republican bill, 
but the reason for that is because you will be buying lousy insurance. 
It is not because Donald Trump, as he said to the country, has provided 
such great healthcare at a tiny fraction of the cost. That is not the 
reason. It is because they provided terrible healthcare at a fraction 
of the cost. That is not a benefit to anybody. If an insurance company 
can put you on lifetime caps, of course they are going to charge you 
less.
  I am all for working together in a bipartisan way to address the 
issues in our healthcare system that, frankly, go far beyond the 
Affordable Care Act to make sure people in America don't have to 
continue to make the choices people all over the world don't have to 
make about having to stay in a job they hate because they have to keep 
the insurance or being able to quit a job and do something else because 
they know the insurance will be there. Nobody else has to make those 
decisions. And nobody else in the world goes bankrupt because of 
healthcare, but that is still a problem in America.
  I think fundamentally the problem we have here tonight is proponents 
of this legislation didn't set out to fix our healthcare system; they 
set out to repeal ObamaCare or the cartoon of ObamaCare they have been 
running on for the last 8 years. That is what they set out to do. Along 
the way, they obscured it all so they could have the opportunity to cut 
taxes on the wealthiest Americans--which, for some reason, is an 
obsession with some people around here--and dramatically cut access to 
healthcare by poor children.
  I know there are people who are hearing this will not believe what I 
am saying is true. It is true. I hope you will familiarize yourself 
with the facts. I hope, in particular, people who feel the last bill we 
considered on this floor didn't get the process it deserved--people who 
quite rightly wanted to make sure Members of the Senate and the House 
had actually read the bill, people who wanted to know what it was like 
to live in a country where your health insurance is uncertain from 
month to month, where you have to decide between paying the rent, 
buying the food or being on health insurance; people who are dealing 
with and whose families are dealing with the effects of this terrible 
opioid crisis that wasn't even really a gleam in our eye when we passed 
the Affordable Care Act.
  I especially say to people living in rural America how sorry I am 
that people aren't paying attention to your needs; that your hospitals 
may be cut because of an ill-considered piece of legislation which has 
nothing to do with delivering healthcare in rural Colorado or rural 
America.
  We can do so much better than this, but to get to a place, 
unfortunately, where Democrats and Republicans have the opportunity to 
work together, the first order of business has to be to defeat the bill 
on the floor. I hope people know this is the week when it is critical 
to call and let your voices be heard, let people know you expect 
something better than what we are getting, and that Americans ought to 
have a healthcare system that is affordable, that is predictable, and 
that actually creates stability instead of instability for their 
families.
  Mr. President, 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. BENNET. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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