[Congressional Record Volume 163, Number 110 (Tuesday, June 27, 2017)]
[Senate]
[Pages S3784-S3794]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                         HEALTHCARE LEGISLATION

  Mr. WYDEN. Mr. President, the last few days have proven, once again, 
that political change in America doesn't start in Washington, DC, and 
then trickle down. It is from the bottom up.
  Because millions of Americans called and texted and tweeted their 
opposition to an abomination of a health plan, that plan is not going 
to be on the Senate floor this week, thanks to grassroots America. It 
is so appropriate at this hour. I also want to make clear we have a 
bottom line for the next 2 weeks. We have an incredible amount of heavy 
lifting we have to do to make sure working families and seniors get a 
fair shake from the American healthcare system.
  I say that because, as we speak, Senate Republicans are at the White 
House strategizing with the President. The horse-trading has already 
begun, and the Senate Republicans have a slush fund paid for by working 
families that contains hundreds of billions of dollars that can be used 
for sweetheart deals that would get them the 51 votes needed to pass 
this horrendous healthcare bill in the U.S. Senate.
  Now I will turn to what we need to focus on in the next 2 weeks at 
townhall meetings, civic group lunches, discussions with rural 
healthcare providers. That focus has to be to highlight what this 
flawed Republican bill really means and how it can't be fixed no matter 
how much money the Republican leadership throws at these problems. This 
bill is a healthcare smash-and-grab, designed to benefit the fortunate 
few, and is paid for by hundreds of billions of dollars in reductions 
from Medicaid--tax breaks for the wealthy that Senate Republicans are 
so anxious to dole out, they are willing to make them retroactive. 
Contrary to what Senate Republicans say, their tax changes don't create 
jobs. They do create tax windfalls.
  Exhibit A, under their bill, you have a $1 million capital gain in 
February, and, if this bill passes, that lucky person would get a 
$38,000 tax break. Many of these gains go directly into the pockets of 
America's 400 most affluent families, while disabled kids, those with 
opioid addictions, and families where a baby boomer has the misfortune 
of having a stroke and needs nursing home care face the prospect that 
the crucial health services they need--services that are life and death 
for them--will not be there because of this flawed healthcare bill.
  Next, I want to point out that over the next 2 weeks, we are going to 
lay out how this legislation would send costs into the stratosphere for 
millions and millions of Americans. Start with older people who are 
about to get hit by what I call a double-age tax. If this bill goes 
through, insurance companies will have a green light to charge older 
Americans more than they charge younger people. As if that doesn't 
raise their costs enough, older Americans are also going to be forced 
to pay a higher share of their income on healthcare costs because the 
Senate Republican bill shrinks their tax benefits as they age. Older 
Americans need more healthcare. They can't afford to skimp out on bare-
bones insurance. So many of our older people are going to see their 
premiums nearly quadruple.
  It is not just older Americans who are going to see their costs jump. 
Right off the top, hundreds of thousands of middle-class families 
across the country are going to lose tax cuts for healthcare because 
the Republican bill snatches away their eligibility.
  When it comes to the private insurance market, this bill is centered 
on a plan to push Americans into bargain-basement healthcare coverage. 
After all the talk about deductibles and out-of-pocket costs being 
unaffordable, this

[[Page S3785]]

Republican proposal ties middle-class benefits to high-deductible, low-
value insurance plans. It is a sleight of hand to make it look like 
consumers are getting a better deal and lower premiums.
  Here is the reality. Of course you can make premiums go down if you 
force people into insurance that only covers bandaids and a bottle of 
aspirin. When people get sick or suffer an injury, they are going to 
read the fine print on their insurance. With this legislation, if it 
were to pass, they would see sky-high deductibles and cut-rate 
coverage. For working families, they would face the prospect they would 
get buried under medical debt because their insurance doesn't cover the 
care they actually need.
  Finally, not even people who get their insurance at work--those folks 
probably thought they were home free in this debate--not even folks who 
get their insurance at work are safe from the Senate Republican 
healthcare plan. Four million Americans are going to lose their 
employer-sponsored insurance coverage just next year if this bill goes 
through. Tens of millions of Americans could once again face some of 
the worst insurance company abuses--annual and lifetime limits on 
coverage. Those are limits the Affordable Care Act banned, but 
Republicans are proposing to bring them back.
  Let's be real clear. If you bring them back and don't protect people 
from skyrocketing costs, it means that if they develop cancer, they 
could bust through their coverage limit, and, once again, we would go 
back to the days in America where those folks were forced into personal 
bankruptcy because millions of people without coverage will be unable 
to pay for the care they need. People with employer-based insurance are 
going to get hit with a hidden tax in the form of higher premiums.
  So if an American listening to this is considering early retirement, 
think again. The cost could well be too high. If you were thinking of 
leaving your job, becoming an entrepreneur, and starting your own 
business, you can think again. Your costs could be higher under this 
plan, especially if you have specific medical needs.
  Then there is the generation of adults in the workforce today--people 
who are middle class, who are doing everything they can to support 
their families and save whenever possible. They may not be thinking 
about the expense of long-term care, but the fact is, growing older in 
America really costs a lot.
  Because of this bill, millions of people will no longer be able to 
count on Medicaid being there to cover their long-term care in a 
nursing home or at home where they are most comfortable later in life.
  I want to close by way of saying that what we have to do now is make 
sure that--to beat this destructive Republican bill; this is the only 
way to do it--Americans keep tweeting, keep sending letters, keep 
finding rallies to attend, tell your stories about how you are going to 
do worse with this bill. And then tell your friends' stories and your 
family's stories. It is a virtual lock that this bill is going to come 
back around.

  I close today by way of saying that grassroots America, by speaking 
out--the fact that they did that and did all that work I have described 
is why this flawed bill is not going to be voted on in the Senate this 
week. We need everybody over the next 2 weeks, seniors and working 
families and people all across this country--my message is that we need 
you to stay loud because that is the only way we will finally stop this 
bill in its tracks.
  I yield to our friend from Maryland, Senator Cardin.
  The PRESIDING OFFICER (Mr. Grassley). The Senator from Maryland.
  Mr. CARDIN. Mr. President, I want to thank Senator Wyden for his 
leadership on this issue and so many issues, his position as the 
ranking Democrat on the Senate Finance Committee. He serves this body 
very well, and he has done that today in outlining the flaw of the 
healthcare bill that was presented a week ago by the Republican 
leadership and what it would do to our healthcare system.
  I want to acknowledge that I am very proud that I was in the Congress 
when we passed the Affordable Care Act. Today, millions of Americans 
have coverage who didn't have coverage prior to the enactment of the 
Affordable Care Act. I am also proud about the quality of that 
coverage. That coverage has guaranteed benefits so that individuals 
know they will be covered for their needs--no preexisting conditions, 
no caps. It is affordable, and we made sure it was affordable to the 
people of this Nation.
  I have listened to the debate from some of my Republican colleagues 
about how the Affordable Care Act is collapsing under its own weight. 
Nothing could be further from the truth. The problems we are 
experiencing with high increases in the individual marketplace are 
caused in part by the actions of the Trump administration to try to 
undermine the Affordable Care Act.
  Let me give an example in my own State of Maryland, where CareFirst--
the largest carrier in the individual marketplace--sought about a 50-
percent increase in individual rates, and they were very direct. At 
least half of that increase is as a result of the uncertainty of the 
Trump administration putting the cost-sharing payments into the budget. 
That raises the premiums for all of those individuals in the individual 
marketplace. There is also the uncertainty as to whether the Trump 
administration is going to enforce the requirement that people buy 
insurance, which means only the people who have higher risks are likely 
to buy the insurance, raising the price for those who want to buy 
insurance.
  When we talk about the fact that there are increased costs beyond 
what we think are reasonable, recognize that it is the actions of the 
Trump administration that are causing a large part of that premium 
increase, which brings me to the bill that was unveiled last week by 
the Republican leadership. It moves us in the wrong direction in trying 
to fix the problems. It does that because it decimates the Medicaid 
Program. The largest expansion of coverage has been in the Medicaid 
Program.
  This bill will significantly cut back--CBO has scored that a total of 
22 million individuals who have insurance today will lose their 
coverage, but it does more than that. It does that for what reason? Not 
to make healthcare more affordable--it does that in order to give tax 
cuts to the very wealthy.
  I am glad that we now have a little cooling-off period. We are not 
going to come back to the bill for about another 10 days, it looks 
like.
  I want my colleagues to know that as proud as I am of the Affordable 
Care Act, I acknowledge that we can make it better. I hope Democrats 
and Republicans will work together to move in the right direction on 
improving the Affordable Care Act. Let me give some examples.
  We know there is a high cost on the premiums, a higher increase than 
we would like. Why don't we join together to make sure there is 
predictable cost sharing provided to the companies that are in the 
individual marketplace? That would remove the uncertainty and reduce 
the premiums significantly in the individual marketplace. Why don't we 
work together, Democrats and Republicans, to increase the subsidies we 
provide to low- and middle-income families so that the premiums will be 
more affordable? We intended to do that under the Affordable Care Act, 
but after we got the cost scoring, we had to trim that back. Let's work 
together, Democrats and Republicans. Those two changes alone would deal 
with the concern that in the individual marketplace, we are seeing 
large premium increases. Together, we can solve that problem.
  Why don't we work for more competition? I have heard my colleagues 
talk about the fact that some of the insurance companies are leaving, 
and some are mainly because of the uncertainty as to whether they are 
going to get their rightful payments for cost sharing. We can do 
something about that.
  Why don't we, Democrats and Republicans, come together and say that 
there should be a public option with no public subsidy, so it is a 
level playing field of competition? That way, we are guaranteeing to 
every market in the country that there will be coverage for the people 
in your community. That encourages more competition. That gives 
stability in the marketplace. We could do that together.
  Then, Democrats and Republicans, let's work together to bring down 
the

[[Page S3786]]

overall cost of healthcare in this country. We made proposals that--why 
are we paying more for prescription drugs, twice as much as our 
Canadian friends? Because they have an organized market, and they 
negotiate as an organized market. Why don't we come together and say: 
Let's take the entire market that we have for the government paying 
prescription drugs and have one negotiation? That would significantly 
bring down the cost of prescription medicine.
  Why don't we build on efforts that we have done for collaborative 
healthcare, for value-based reimbursement? That would significantly 
reduce the cost. We have seen that in mental health and addiction. We 
could see the same savings in kidney care and in diabetes and heart 
disease.
  There are ways we can improve the Affordable Care Act. Democrats are 
ready to work with Republicans to get that done. What we will not do is 
make this current system worse. We are not going to cut the Medicaid 
Program in order to provide tax cuts to the wealthy. Join us in 
improving the law to make premiums more affordable in the individual 
marketplace, to bring more competition into the program, and to drive 
down the overall cost of healthcare in this country. That is what 
Democrats stand for, and we are ready to work with Republicans today in 
order to get that done. I would encourage our colleagues to work 
together, and let's improve the healthcare system.
  Mr. WYDEN. Will my colleague yield for a question?
  Mr. CARDIN. I yield to my friend from Oregon.
  Mr. WYDEN. I know my friend from Maryland is a real expert on this 
whole matter of private insurance, going back to his days in the State 
legislature, and I was director of the Gray Panthers.
  I think what you are saying is that it is critically important that 
we get more predictability and more certainty in the private insurance 
market. What I am struck by is, of course, this is the private sector. 
This is not the government. This is the private sector. The President 
has been basically pouring gasoline on the fires of uncertainty in the 
private insurance market because he is always in or out on this 
question of cost sharing, and the private insurers then say: We can't 
really predict what our rates are going to be, and maybe we have to 
pull out or we have to raise rates.
  Could the Senator again highlight his thoughts with respect to more 
predictability and more certainty? It is such an important point.
  After my good friend from Maryland has made that point, I know the 
Senator from Delaware is interested in the same subject.
  Mr. CARDIN. Senator Wyden is exactly right. I have met with the 
largest insurer in Maryland. I have gone over their rate requests for 
this year. They told me directly that the largest amount of their 
premium increase request is based upon the uncertainty.
  They don't know whether the cost sharing is going to be put in the 
budget, and they have to make their decisions on rates now. Not knowing 
that, they have to cover themselves, and they are asking for a rate 
increase under the concern that the cost sharing may not be in the 
payment.
  That was not only envisioned, we thought it was mandated in the 
Affordable Care Act. Now the President is talking about: Well, maybe I 
am not going to put it in. And we see some of his other activities. So 
if you are an insurance company and you are answerable to your board of 
directors and you know that this payment is how you are able to get low 
deductibles and copays, but you are not sure you are going to get the 
Federal payment, and you know that your customers are going to want the 
low cost sharing, you have to charge a higher premium just to cover 
yourself. That is exactly what was done in Maryland.
  If the President of the United States had said that money is going to 
go into the program because that is what Congress intended, we would 
have had significantly lower rates in Maryland in the individual 
marketplace. Predictability is critically important.
  Mr. CARPER. Will the Senator yield?
  Mr. CARDIN. I will be glad to yield to my friend from Delaware.
  Mr. CARPER. Senator Cardin and I serve together on the committee 
called Environment and Public Works in the Senate. One of the issues we 
deal with is clean air.
  This conversation about predictability and uncertainty that 
businesses seek is not just in health insurance, it is in all kinds of 
businesses across the country.
  I remember being in a conversation 8, 9 years ago with--I think 
Senator Alexander of Tennessee was with us. We met with the CEOs of a 
number of utilities across the country. Senator Alexander and I were 
pushing legislation in response to President George Bush's proposal 
called Clear Skies. It was designed to reduce the emission of sulfur 
dioxide, nitrogen oxide, mercury, and CO2, carbon dioxide. 
We talked with these CEOs from across the country for an hour in my 
office. We had been talking about reductions of X percent and Y percent 
and so forth in the emissions from these harmful pollutants from 
primarily coal-fired utilities. At the end of the conversation, this 
one older fellow who was representing a utility in the southern part of 
our country--he was sort of a curmudgeon-like person--he said: Senator, 
this is what you need to do with respect to the restraint on emissions, 
reduction in emissions. Here is what you need to do. You need to tell 
us what the rules are going to be. You need to provide us some 
certainty and predictability and give us a reasonable amount of time to 
comply and then get out of the way.
  I will never forget that conversation. Tell us what the rules are 
going to be, provide us with some certainty and predictability, a 
reasonable amount of time, and get out of the way.
  It is not just utilities that want certainty and predictability, so 
do others, and particularly, as utilities are a regulated industry, so 
is insurance. They do like to have predictability and certainty.
  We tend to focus just on the exchanges and the marketplaces in the 50 
States, which provide health insurance for maybe 5, 6, 7 percent of 
Americans who get healthcare coverage. Most people get their healthcare 
coverage from employer-provided programs. Maybe 20, 25 percent get 
their coverage through Medicaid.
  I used to think Medicaid was healthcare for poor women and children. 
When I was elected State treasurer, I used to think Medicaid was 
healthcare for poor women and children and not much else, and it turns 
out, it is a lot more than that today. Twenty, twenty-five percent of 
folks get their coverage there, another 15 percent or so in Medicare, 
and the rest are in the exchanges. Every State has an exchange. That is 
for folks who can't get coverage anywhere else. The idea is to have 
some opportunity to participate in a purchasing pool.
  When we passed the Affordable Care Act, we made a promise that we 
would do the kinds of things that Senator Cardin is talking about to 
provide certainty and predictability for the health insurance companies 
when they insure in these exchanges. The health insurance companies 
were reluctant to provide coverage to the folks who were going to get 
coverage through the exchanges. As my friend will recall, some of these 
people hadn't had healthcare for months, years, maybe even decades, and 
maybe some never had healthcare in their lives, so nobody really knew 
how much healthcare they would need, except we knew and the insurance 
companies knew that these people would need a lot. As my friend said, 
we provided some ways of reducing that lack of predictability. It is 
like the comic strip ``Peanuts,'' with Lucy and Charlie Brown and the 
football. When she pulls the football away, she always fools him. He 
still kicks and misses every time. We sort of did that with the 
insurance companies. We assured them we would help provide stability, 
and we took away the very mechanisms designed to do that.

  I think what my friend is saying, we need to come back and provide 
maybe three ways to do it; one, with respect to reinsurance; two, cover 
the risk costs; and the third is to do something--if we don't continue 
with the individual mandate, we need to come up with something like the 
individual mandate, which is not as harmful as Republicans are 
suggesting. I don't think the a 6-month lockout is humane.
  Mr. WYDEN. Will my friend yield?

[[Page S3787]]

  

  Mr. CARPER. I will be happy to.
  Mr. WYDEN. The Senator, as a Governor, really has helped educate me 
over the years on this whole question of the States being 
``laboratories of democracy'' and trying fresh approaches. Delaware has 
done that and Oregon has done that.
  I ask the Senator: As a former Governor, what would it mean to you if 
you are staring at a 20- or 25-percent reduction in Medicaid? Because 
as you know, that is what is contemplated with the Senate Republicans.
  Mr. CARPER. I was Governor from 1993 to 2001. We started in a 
recession and ended up with 6, 7 really strong years, as you recall, 
during the Clinton administration. We were able to balance our budget 8 
years in a row, cut taxes 7 out of 8, pay down some debts, and get good 
credit ratings across the board.
  The person who was my secretary of finance the last 4 years is now 
our Governor, John Carney. Ben knows him pretty well. He was a 
wonderful member of Congress and a wonderful Lieutenant Governor before 
that. He is looking at a budget of less than $4 billion. He is looking 
at a $400 million hole to fill. What is being proposed by our 
Republican colleagues on Medicaid would not make that $400 million hole 
any smaller. It would add anywhere from $100 to $200 million--
increasing it anywhere from 25 percent to 50 percent. It is a killer. 
Our Governor and our legislature are struggling enough to try to fill a 
$400 million hole rather than trying to figure out how to deal with 
something as vibrant as $600 million. It would be a backbreaker. That 
is what we are looking at. I share that with everybody.
  Going to my ``laboratory of democracy,'' some people would like to 
have Medicaid for all. Several of our colleagues are very much 
interested in a single-payer system. As an old Governor--someone who 
had the privilege leading the National Governors Association--I am a 
believer that States can be that laboratory of democracy. They can take 
ideas and show us it is a good idea for the country and other States or 
take ideas and prove they are bad ideas. We ought to enable them to do 
that.
  Mr. WYDEN. I thank my friend. Would my friend like to add anything 
else or should we yield to Senator Cantwell?
  Mr. CARPER. I want to say a kind word about our Presiding Officer. He 
heard me say this before. I will say it again. He may recall having 
cosponsored legislation in 1993, offered by John Chafee and cosponsored 
by Orrin Hatch and others, that actually had a lot of good ideas in it. 
It had the idea of establishing exchanges in all 50 States. Having the 
sliding scale tax credit brought down the cost of healthcare insurance 
to lower income people in the exchanges with a bigger tax credit. It 
had the individual mandate in there to make sure young, healthy people 
got coverage too. We didn't leave health insurance coverages to a pool 
of unhealthy young people to try to insure.
  We added employer mandates so a certain number of employers had to 
participate. There was prohibition against insurance companies denying 
coverage. I want to say, our Republican friends took that idea--and 
Mitt Romney used that idea to establish RomneyCare when he was Governor 
of Massachusetts. It worked there. It wasn't perfect. It took a while, 
but it worked. I would just say, we shouldn't give up on that idea. We 
should not give up on that idea. There are ways we can fix it. Senator 
Cardin talked about some of those ways, and I am sure Senator Wyden as 
well.
  I just heard John Kasich on one of the shows on TV. He said he was 
with Governor Hickenlooper. We have to stop being Democrats on this or 
Republicans on this. Folks want us to be Americans on this and work 
together. That is what I would like to do. I think we can do that in a 
way that brings credit, not just to our party but really to our 
Country. It accomplishes the three things the President talked about 
for a while: coverage for everybody, better quality coverage for less 
money. There is no way Democrats by themselves or Republicans by 
themselves are going to do that. If we work together, all things are 
possible.
  Mr. WYDEN. Before Senator Cardin leaves the floor and we yield to our 
friend from Washington, who is also so knowledgeable about healthcare, 
on this point with the States being the laboratories of democracy, 
during the debate with my colleagues over the Affordable Care Act, we 
wrote a provision, 1332. It gives the States the authority to do 
better, to come up with, as the distinguished Senator from Delaware, 
Mr. Carper, said--it is a chance to do better and try out those fresh 
ideas on my colleagues.
  The problem is, with the Senate Republican bill, they are talking 
about giving the States the right to do worse, to waive out some of 
these essential protections. Again, I think this is natural for 
something that could be bipartisan, where Democrats and Republicans 
could work together to really encourage States to do better. Let's not 
go the other way and abuse that provision in the Affordable Care Act so 
States can work.
  The PRESIDING OFFICER (Mr. Burr). The Senator from Washington.
  Ms. CANTWELL. Mr. President, I join my colleagues here from the 
Finance Committee. Although I don't want to admit it, it was 10 years 
ago that we had this discussion in the Finance Committee--my colleagues 
from Maryland, from Delaware, and from Oregon. What people don't 
realize--even the Presiding Officer knows we spent a lot of time 
talking about healthcare. This was not ``let's have a few meetings and 
roll out a bill.'' There was a very long period. In fact, the Chair 
knows that, in fact, our side got a lot of heat for a lot of dialogue 
that happened with him and our colleague from Maine at the time--a lot 
of heat for dialogue with her. I think there was a period of time, 
about 6 or 7 months, where every single day I went to at least one 
thing in the discussion of the healthcare policy--at least one thing 
every day for like 6 months. That wasn't even the markup. Those weren't 
even the meetings. That was just the time period where the committee 
had designated various subgroups so we would talk about policy.
  I don't know if the two of you remember that period, but my 
recollection is every single day I was going to something regarding the 
healthcare policy and listening to experts and recommendations, and 
then, of course, we had these--I call them more roundtables than 
hearings. We had a lot of roundtable discussions, and we obviously went 
through a very formal bill process.
  There is a little bit of irony that we are the ones out here today 
still talking about this healthcare bill. I think it is because we knew 
what the challenges were, and we tried to address them and were not 
afraid to keep addressing them. We are not afraid to be out here today 
talking about solutions we want to see as well.
  I thank my colleague from Delaware and my colleague from Oregon for 
both being part of that effort because it really was an unbelievable 
amount of time and energy and discussion and formulation. The notion 
that somehow now we would take something that is one-sixth of the 
economy and draft something up in a dark process, then throw it out 
here--I am not surprised today that there aren't the votes. The thing 
to do now is not try to just rack up some votes in the next few days 
and come back in July. The thing to do is to sit down and have a 
serious discussion.
  I notice a couple of my colleagues are down at the White House. They 
are positioned right there next to the President. Maybe they are trying 
to put them on the hot seat. He is sitting there talking about the 
individual market. He is talking about the individual market in Alaska. 
All I am thinking is that the individual market in Alaska--we are 
sitting here, and the other side is proposing to cut 15 million people 
off of Medicaid. What does that have to do with the individual market? 
Nothing.
  I don't know if people are ready to focus on this the way we focused 
on it in that time period for more than a year--more than a year, day 
after day, meeting after meeting, hearing after hearing. I hope what 
they will do is stop this proposal and sit down and have an open 
process and have a discussion on these policies because they are so 
important.
  We have been having all this discussion, and a lot of the frustration 
people have talked about is the individual market, where 7 percent of 
Americans

[[Page S3788]]

get health insurance. There are ways to fix and improve the individual 
market. I feel like I was fortunate enough to put forward one of the 
better ideas that worked successfully, at least it is working 
successfully in the State of New York, the Basic Health Program. So 
650,000 people are on the Basic Health Program as a proposal. I think 
they call it, in that State, the Essential Plan. Two adults in a family 
of four can buy a policy for about $500 in premiums, on an annual 
basis, instead of about $1,500 on the exchange for that population that 
is above the Medicaid rate that needed to have a solution in the 
marketplace. There are 13 different companies offering insurance to 
those 650,000 people, so that is obviously working.
  Now, it got implemented late. New York did it in 2016 because they 
were off to the races, but other States should now consider this. What 
is so great about this and helping to address the individual market is 
because, where we are on this side, we are willing to allow individuals 
who don't work for a large company to get the same clout as if they 
worked for a large company. When you buy in bulk, you get a discount. 
Americans know that. That is why they shop at Costco. If you go there 
and buy in bulk, you get a discount. That is what they are doing in New 
York. So 650,000 people have been bundled up like they are a big 
company and saying to the marketplace: Who wants to bid on selling us 
insurance? The end result has been more affordable insurance in the 
individual market. That is what they should be discussing down at the 
White House today. That is what they should be discussing, not cutting 
15 million people off Medicaid. That is not a smart idea.
  I am sure my colleagues here have already gone over this notion that 
once you cut people off of care, they end up in the emergency rooms or 
have exacerbated healthcare needs. So there are longer periods of time 
to get access to healthcare, more complicated healthcare costs, rising 
premiums.
  We have gone around our State and heard loud and clear from the 
provider community and the hospitals that they have seen downward 
pressure on the price of private insurance because we expanded 
Medicaid, and the economic numbers are out there now to show the same 
thing. Cutting people off of Medicaid is not the solution to the 
individual market. I hope somebody down there at the White House brings 
that up.
  In 2020, when the Medicaid cap--if it did go into effect--the 
analysis is it would cost shift $324 million per year to my State. They 
would be cutting people off of Medicaid, and then basically the cost 
would be $324 million a year to our State. You can imagine that our 
State doesn't have that money and isn't interested in picking up that 
tab. By 2028, when the Medicaid cuts start to kick in, we would be 
cost-shifting $4.2 billion per year to the state of Washington. That is 
not smart economics for us.
  Over the weekend, I visited Virginia Mason Hospital in the 
northwest--again, a great success in delivery system reform. They 
implemented the Toyota model of production. There is, literally, faster 
turnaround time on lab reports and better expedience of nursing care. I 
think there was something like a 72-percent reduction in insurance 
liability costs. I mean, there are huge successes by changing and 
improving the delivery system that helps put pressure down on price. 
This is what we need to be talking about.
  There is much innovation that was in the Affordable Care Act. We need 
to now ask the question: What further things do we need to do to make 
sure we drive down costs in the individual market as well? But with 
this Senate bill, you are not going to drive down price. There are 
reports now out by the Center on Budget and Policy Priorities last 
Friday that show the price will actually go up in the individual market 
if you cut people off of Medicaid. Basically, it will just increase by 
several thousand dollars the actual amount of money the people in the 
individual market will have to pay for insurance, so that clearly is 
not the solution.

  I urge my colleagues on the other side of the aisle--I hope they come 
back and say that it is time to work in a discussion about these ideas 
in a broad way, not just another Hail Mary pass. Just get rid of this 
notion that cutting poor people off of Medicaid is somehow going to 
magically fix the individual market. It is not. I thank my colleagues 
from the Finance Committee who went through all of that.
  Believe me; I am telling you, these discussions went on for weeks and 
weeks and weeks. Some people here are trying to come up with a score 
and get an answer in a week on this entire package. I think we debated, 
I would say, probably 2 or 3 weeks just on the notion of reforming--
getting off of fee-for-service and focusing on a value index and 
getting the priorities of the delivery system focused on better 
outcomes at lower costs. This is something that really should be a big 
priority in healthcare.
  I remember we had private meetings. We had the head of CBO come down 
and talk to us. We had hearings. We probably spent 3 weeks just on one 
concept of how effective that would be in the healthcare delivery 
system.
  I see we are still here. We are still talking. We are still willing 
to improve this delivery system and make sure people have better access 
to care, and I thank my colleagues for including me in this discussion 
today.
  I want to again thank the Senator from Oregon, the ranking Democrat 
on the Finance Committee. I know he knows exactly what I am talking 
about when we talk about innovation. There is so much innovation he put 
into the Affordable Care Act, giving states discretion. They already 
have all the discretion they need; they have all the discretion they 
need to keep innovating.
  Hopefully we will get our colleagues to follow suit because this is 
where we are going to deliver better care at lower costs and help 
improve the access for everybody in America.
  I thank the Senator from Oregon.
  Mr. WYDEN. Mr. President, I thank the Senator from Washington State 
who was for care coordination, moving away from fee-for-service, using 
bargaining power, locally driven approaches long before it really 
became a buzzword in American healthcare. I thank her very much for 
this.
  Mr. CARPER. Mr. President, may I ask the Senator from Oregon to yield 
for about 30 seconds?
  Mr. WYDEN. Mr. President, of course.
  Mr. CARPER. Mr. President, something the Senator from Washington said 
just reminded me--after we heard the news that Republicans are going to 
go back to the drawing board and see what they can come up with maybe 
during the Fourth of July recess, I did a radio interview with a 
station back in Delaware. One of the questions the interviewer asked me 
was: Well, the Republicans have a lot of money to play with; I hear a 
couple hundred billion dollars. Won't the Republican leaders just offer 
money to one Senator after the other after the other to find out what 
they need in order to get them to support this?
  I said: I hope not. I hope that is not what happens. This is a time 
when we need to hit that pause button and, rather than dole out money 
to try to draw this Republican or that Republican to come into the 
fold, if you will, why don't we just spend some time in the rooms the 
Senator from Washington was talking about.
  We spent all that time--a lot of time together, with Democrats and 
Republicans in hearings, public hearings, private meetings, 
roundtables, and so forth. That is the kind of thing we need to do over 
again. If we do that, we might be surprised. We might surprise the rest 
of the country about how well that would work out.
  Thank you.
  Mr. WYDEN. Mr. President, I thank my colleague.
  Senator Warner.
  Mr. WARNER. Mr. President, let me join my colleagues on the Senate 
Finance Committee and not only express my concern about how we got 
here, but also acknowledge that an awful lot of folks in Virginia and a 
lot of decent folks in North Carolina and folks across the country 
breathed a little bit of a sigh of relief today. But that sigh of 
relief was just the fact that we have a bit of a reprieve from a 
proposal that, in my years here, I don't think I have ever seen--
  The PRESIDING OFFICER. The Senator from Virginia will suspend for a 
moment.

[[Page S3789]]

  If the Senators are going to carry on a colloquy, the Senator from 
Oregon has to remain standing.
  Mr. WYDEN. I thank the Presiding Officer. At this point, we are just 
going to hear from Senator Warner.
  The PRESIDING OFFICER. The Chair recognizes the Senator from 
Virginia.
  Mr. WARNER. Thank you, Mr. President.
  Again, I am here joining my Democratic colleagues from the Senate 
Finance Committee.
  I believe that folks in Virginia and, for that matter, folks across 
the country got a reprieve today when the majority leader indicated 
that we were not going to vote on the piece of legislation that he 
brought forward, a piece of legislation which, as has been acknowledged 
by the CBO, would take 22 million Americans off of healthcare, would 
transfer close to $800 billion of costs currently borne jointly by both 
the Federal and State partnership in Medicaid and then thrust that cost 
upon the Governor of North Carolina, the Governor of Virginia, and a 
host of others. I can't recall in my time here in the Senate where a 
proposal has been as universally panned by organizations from the left, 
right, center, and everywhere in between.
  As perhaps the President is now acknowledging with the majority 
leader and a number of other Republican Senators, using his own quote, 
that ``nobody knew healthcare [was] so complicated.'' The fact is, the 
vast majority of Members on both sides of the aisle have realized 
healthcare is extraordinarily complicated. It is why it took years to 
fashion the ACA and why there are many of us, again, on this side of 
the aisle who continue to say we acknowledge, years after 
implementation of the ACA, that there are many things that need to be 
fixed, but the only way they are going to be fixed is if we do it in a 
bipartisan fashion.
  Instead, the legislation that we were going to vote on tomorrow would 
have actually made healthcare much more expensive, less affordable, and 
less accessible for a whole wide breadth of Americans. Don't take my 
word for it; don't take these other elected officials' word for it. 
Let's look at well-respected, bipartisan groups.
  The American Cancer Society said that the bill the majority leader 
put forward ``would be devastating for cancer patients and survivors.'' 
The American Medical Association said that the majority leader's 
proposal violates the very first dictate of the Hippocratic oath, which 
says ``do no harm.'' Obviously, this bill would have done a great deal 
of harm. The American Academy of Pediatrics says ``The bill fails [our] 
children.'' The National Center on Addiction and Substance Abuse says 
the Republican proposal ``will crush efforts to end the opioid 
epidemic.'' And the AARP says the proposal ``would leave millions, 
including our most vulnerable seniors, at risk of losing the care they 
need.''
  But it is not just these leading healthcare organizations that have 
come out uniformly and virtually universally against what the majority 
leader had proposed. I am also hearing that from Virginians. On Monday 
of this week, I attended an opening of the new PACE Program in Fairfax, 
VA. The PACE Program--I know the ranking member on the Finance 
Committee has been a big advocate of the PACE Program--is a program 
that works in an extraordinary way at keeping seniors in their homes 
rather than having them migrate to nursing homes. Well, folks at the 
PACE Program in Fairfax were more than disturbed when they heard that 
the majority leader's proposal cuts Medicaid by $772 billion. Medicaid 
allowed so many folks to get access to healthcare, particularly if they 
had individuals in their family who might have severe disabilities. The 
majority leader's proposal, the per capita caps would actually take 
away the amount of health insurance they could receive.
  The truth is, Medicaid covers 28 percent of all Americans and covers 
about 40 percent of all poor adults and seniors. In my State of 
Virginia, for those folks in PACE or in nursing homes, literally two-
thirds of seniors who receive any kind of care receive care through 
Medicaid.
  The cuts in this proposed bill would devastate our seniors and their 
families, and the cuts will not save money because so much of this is 
just the old-fashioned trickle-down that trickles down this 
responsibility to States that, again, would have to either raise their 
own taxes to take care of their responsibilities or, frankly, put out 
seniors who receive this critical care.
  Mr. President, I also want to share with you and my colleagues a 
meeting I had last week with a series of families who came in. They had 
children or adults who had devastating disabilities.
  I heard in particular from Marlo Dean from Virginia Beach, who was 
there with her 15-year-old son Dante, who has extensive health needs 
because of a rare brain disorder. Dante had just received a Medicaid 
waiver after being on the waiting list for 10 years. Ms. Dean, Dante's 
mother, said:

       Cutting Medicaid is not the right thing. It's not the 
     humane thing.

  There were other families. Angie Leonard, who traveled from the 
Roanoke Valley with her 22-year-old son Joshua, who has autism, said 
that this is not what America ought to be about.
  Rebecca Wood, who brought her daughter Charlie from Charlottesville, 
said that she has private insurance, but she is wondering what would 
happen when that private insurance hits its cap, a cap that had been 
removed when we put in place the ACA. Again, Rebecca said: ``Our 
country is better than this.'' Boy, oh, boy, is she right.
  When our colleagues talk about cutting Medicaid, when they talk about 
cutting it at the numbers they are talking about or putting caps back 
in place, I hope they realize that this is more than about the numbers 
of a government program. This is about providing support and services 
to families facing the nightmare of chronic illness or crippling 
medical illness and bills, quite honestly, that they can't pay on their 
own. It is about peace of mind for these families.
  I have said from the outset that there were mistakes made in the ACA, 
and I stand ready to work with any Member of either side of the aisle 
to make sure that we fix those mistakes. But this debate ought to be 
about healthcare reform, not about providing the wealthiest in our 
country a tax break they don't need or taking hundreds of billions of 
dollars out of Medicaid.
  I look forward--I hope our colleagues who come back from this meeting 
with the President will come back with a renewed sense of cooperation 
and collaboration. I know there are other members of the committee who 
want to speak on this issue. I stand prepared to work with them and the 
ranking member from the Finance Committee to do this right, but it 
ought to be done in a way--whether it is Rebecca and her daughter 
Charlie, whether it is Ms. Dean and her son--that they get a chance to 
have their voices heard through a regular order process, where at the 
front end of the process we can hear the concerns, get those concerns 
vetted, and make sure legislation that gets brought to the floor is 
fully vetted and actually improves the quality of care for Virginians 
and Americans all across this country.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. WYDEN. Mr. President, before he yields the floor, I just want to 
thank Senator Warner for his insightful comments. As a Governor, he 
really understands why a Medicaid cut of hundreds and hundreds of 
millions of dollars is going to permanently damage the lives of so many 
people in Virginia. I thank him for his comments.
  Let me yield now to Senator Menendez.
  The PRESIDING OFFICER. Does the Senator from New Jersey seek 
recognition?
  Mr. MENENDEZ. Mr. President, I do.
  The PRESIDING OFFICER. The Senator from New Jersey is recognized.
  Mr. MENENDEZ. Mr. President, call me old-fashioned, but as a member 
of the Senate Finance Committee, I still believe the legislative 
process matters, especially when you are dealing with matters of life 
and death, like healthcare.
  In 2009 and 2010, we had a painstakingly open, deliberative process 
while drafting our healthcare reform bill.
  In the Senate Finance Committee alone, we held 53 hearings, 
roundtables, and meetings, consulting with patients, advocates, 
doctors, and industry leaders.
  Only after months of bipartisan negotiations and marathon markups did 
we bring the healthcare bill to the floor, and when we did, we spent 25 
days debating it in full view of the American

[[Page S3790]]

people. That is how we passed a law that protected Americans with
preexisting conditions. That is how we stopped health insurance 
companies from dropping consumers the moment they got sick. That is how 
we passed a law that delivered coverage to 9 out of 10 Americans for 
the first time in history.
  Because when you have an open, deliberative, bipartisan process, you 
can deliver real progress to millions of Americans. But when you have 
an ugly, partisan, backroom process, you get an ugly, partisan bill. 
And that is what we have with the Senate Republican healthcare bill.
  It is an ugly bill, born out of an ugly process with ugly 
consequences for the American people.
  And you don't have to take my word for it. Just last night, the CBO 
confirmed that the Republican health bill will leave 15 million more 
Americans uninsured next year--and 22 million uninsured by 2026.
  And mind you, this is the plan that Republicans promised would be so 
much better than the unpopular, disastrous legislation passed by House 
Republicans earlier this year.
  Well, if Trump thought the House healthcare bill was mean, then the 
Senate Republican plan is downright nasty.
  It is really quite simple. Republicans want to give the 400 
wealthiest families in America--the Warren Buffets and Donald Trumps of 
our society--a huge tax cut they do not need, paid for by taking 
healthcare away from those who need it the most.
  For years, Republicans railed against the Affordable Care Act, and 
pledged they would repeal and replace it with something better. But 
under the plan they put out last week, the only people who are better 
off are millionaires and health insurance company executives.
  Across the board, Americans will pay the price. They will pay higher 
premiums, higher out-of-pocket cost, higher deductibles--all for less 
comprehensive coverage. That is because the GOP plan still rolls back 
key consumer safeguards, like protection from lifetime limits and 
coverage for preexisting conditions.
  It still ends the Affordable Care Act's Federal guarantee that every 
health plan cover essential health benefits, like prescription drugs, 
prenatal care, hospital stays, and more. It still defunds Planned 
Parenthood and saddles women with higher costs. It still imposes a 
crushing age tax on middle-aged Americans.
  My Republican colleagues like to say that this bill gives Americans 
more choice over their healthcare. But I have heard from countless New 
Jerseyans in recent weeks who know that under the Republican health 
plan, they will have no choice but to go uninsured.
  I have heard from older workers, like Howard in Park Ridge, NJ.
  He writes: Without subsidies provided under the ACA, my 51-year-old 
wife and I would have no insurance. We could not afford premiums in 
excess of $1100 a month. . . . Without these subsidies millions will go 
uninsured and many of these people, myself included, will die.
  If all the choices Republicans provide workers like Howard are 
unaffordable, what good are they? That is not choice. That is a death 
sentence.
  Or consider the half a million low-income New Jerseyans who secured 
coverage thanks to the ACA's Medicaid expansion.
  My Republican colleagues call them ``able-bodied adults.'' But they 
aren't able to even afford a trip to the doctor under this bill. Many 
of them have low-wage jobs that don't come with health benefits--
dishwashers, cashiers, home health aides. These are the people I grew 
up with in Union City. These are the people abandoned by the 
Republicans' heartless healthcare plan--people like Alton Robinson of 
Morris County. He credits Medicaid expansion with saving his life.
  Alton struggled with addiction for nearly two decades. Medicaid 
enabled him to get substance abuse treatment and the physical and 
mental healthcare.
  Today, Alton is clean. His life is on track. And he spends his 
working days helping other New Jerseyans get on the path to recovery.
  Republicans' cruel bill leaves millions of people who rely on 
Medicaid expansion with no options at all. And for what? To give health 
insurance executives, real estate moguls, and hedge fund managers a 
massive tax cut they don't need?
  According to New Jersey Policy Perspective, a handful of New Jersey 
millionaires and corporations get a $15 billion tax cut under this 
terrible Republican health plan, while over half a million people lose 
their coverage.
  And, of course, this legislation goes far beyond ending Medicaid 
expansion. It ends Medicaid as we know it.
  Their plan fulfills a decades-old right-wing mission to shred the 
social safety net--forcing the most vulnerable among us to pay for tax 
cuts for the richest among us.
  It has nothing to do with giving States more choice over how to run 
Medicaid. Because when you slash Medicaid by nearly $800 billion, you 
leave States with no choice but to provide less care. When you cut 
Medicaid funding by $60 billion in New Jersey, you leave the State with 
no choice but to abandon the most vulnerable--people like Leandra, the 
13-year-old girl I met last week in Newark. She suffers from a rare 
muscle disease that leaves her confined to a wheelchair, too weak to 
walk and in extraordinary pain. She takes 18 medications each day. She 
has survived 19 surgeries.
  Leandra can't speak out against this horrible, cruel Republican 
healthcare bill that would jeopardize her life. But we can. And we must 
continue to be Leandra's voice until Republicans finally hear her.
  That is the kind of process we need when we talk about healthcare--a 
process that gives voice to the voiceless.
  So today I say to Americans everywhere: don't sit on the sidelines. 
Don't be silenced. Make your voices heard. Tell Republicans what this 
heartless healthcare plan means for your families and your future.
  Mr. President, I have a group of Nordic Parliamentarians I am hosting 
in a few minutes. Let me say that I join my Senate Finance Committee 
colleagues in this effort because I still think the legislative process 
matters, especially when dealing with matters of life and death like 
healthcare.
  To reiterate, in 2009 and 2010, we had a painstakingly open, 
deliberative process while drafting our healthcare reform bill. In the 
Senate Finance Committee alone, we held 53 hearings, roundtables, 
meetings, consulted with patients, advocates, doctors, industry 
leaders, and only after months of bipartisan negotiations and marathon 
markups did we bring the healthcare bill to the floor. And when we did, 
we spent 25 days debating it in full view of the American people. That 
is how we passed a law that protected Americans with preexisting 
conditions. That is how we stopped health insurance companies from 
dropping consumers the moment they got sick. That is how we passed the 
law that delivered coverage to 9 out of 10 Americans for the first time 
in history.

  When you have an open, deliberative, bipartisan process, you can 
deliver real progress to millions of Americans, but when you have a 
backroom, partisan process, you get an ugly, partisan bill, and that is 
what we have with the Senate Republican healthcare bill. It is an ugly 
bill in terms of what it does to people, it is born of an ugly process, 
and it has ugly consequences for the American people.
  Just last night, as we all heard, the CBO, the Congressional Budget 
Office, a nonpartisan scoring division for all of us, Republicans and 
Democrats alike, said 22 million people will lose their health 
insurance and 15 million next year if the law were to pass.
  Mind you, this was a law that was supposed to be better than the 
House Republican version. Well, that bill was mean, this bill is 
downright nasty. It takes healthcare away from those who most need it, 
only to give tax cuts to the Warren Buffetts and Donald Trumps of the 
world, who, fortunately for them, don't need it.
  It is amazing to me that for years I have heard my Republican 
colleagues rail against the Affordable Care Act--or as they call it, 
ObamaCare--and pledge to repeal it and replace it with something 
better. They had 7 years to come together and decide what that would 
be, and then, on a plan that was put out only late last week, we see 
the consequences of something that was rushed together by 13 men, no 
women, and nobody creating the diversity of America that relates to 
their

[[Page S3791]]

healthcare. That is fundamentally wrong, and I am not surprised that 
many of my Republican colleagues revolted against it--at least at this 
point. The question is whether they will continue to demand of their 
party and of all of us the type of healthcare that we want to see for 
each American, because under the plan as it was proposed, Americans 
will pay higher premiums, higher out-of-pocket costs, higher 
deductibles, all for less comprehensive coverage--pay more for less.
  It rolls back key consumer safeguards. There is a difference between 
a guarantee--when we hear the word ``entitlement,'' we are really 
talking about a guarantee against lifetime limits. You have a serious 
disease, and you come up to that cap in your insurance. You still have 
the disease, you still have cancer, you are still treating it, you are 
still fighting it, you are trying to save your life, but you don't have 
any more money because there is no more insurance coverage. We 
eliminated that under the law. There is no guarantee of continuing that 
safety under the Republican bill.
  There is no guarantee that when you give States waivers, the way in 
which they treat those waivers--that you truly have a guarantee against 
preexisting conditions being a prohibition to getting healthcare.
  Finally, if you are middle class and middle aged, this bill gives you 
nothing. Nothing. If you are an older American, it costs you 
enormously.
  Let me make my final point about Medicaid. Look, I am tired of 
hearing about Medicaid being only about the poor, as if the poor don't 
deserve health insurance. They certainly do. But Medicaid is about a 
lot more than the poor. In my home State of New Jersey, 60 percent of 
recipients are either seniors or those who are disabled. They didn't 
choose to be disabled; they either were born with or developed a 
disability. They deserve the full potential of their God-given 
potential, as anybody else does. Medicaid provides them healthcare so 
they can be a successful part of our society. Medicaid provides seniors 
with dignity in the twilight of their lives. Medicaid provides for 
pregnant mothers who may not have insurance elsewhere. Medicaid takes 
care of special education children in our schools. And, yes, Medicaid 
takes care of the poor.
  Medicaid expansion helps those who go to work in some of the toughest 
jobs in my State and in our country. They have the dignity of having 
healthcare and being able to stay healthy so they can work. We want 
them to work. Yet we take away the healthcare that is the very essence 
of what keeps them healthy so they can work. That is not the America I 
know. That is not the healthcare that was promised.
  We can do better, and we can do better together. What we need to do 
is get over the mantra of, let's just repeal the Affordable Care Act 
instead of improve it. If you want to improve it and improve the 
healthcare of Americans, you are going to find a lot of Democrats ready 
to do that, myself included.
  With that, I yield the floor.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. WYDEN. Mr. President, I believe we are very close to consuming 
the hour that the Finance Democrats have, so I ask unanimous consent 
that at this time Senator Casey be recognized for his remarks and at 
the conclusion of his remarks, I be recognized for some final comments.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  The Senator from Pennsylvania.
  Mr. CASEY. Mr. President, I seek recognition to continue this 
discussion on healthcare, and I ask unanimous consent to speak in 
morning business.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. CASEY. Thank you, Mr. President.
  I rise to talk about an issue that some of us have talked about, but 
I think it is an issue that is barely breaking through now. There has 
been a lot of discussion in the debate so far about various aspects of 
the bill. We know the bill in its current form is about 142 pages, I 
guess, and more than 60 of those pages deal with one topic--Medicaid. 
So this is basically a Medicaid bill and a tax cut bill, and the two 
are not just referred to on a regular basis in the text, but I would 
argue they are actually in conflict with one another.
  I was on the floor last night showing a chart that indicated that the 
top 400 households in the country would get a tax cut of $33 billion. 
Just imagine that. Four hundred families get $33 billion out of the 
bill--the House bill, but it hasn't changed substantially at all when 
it comes to tax cuts--and then on top of that, the Medicaid cuts in 
just four States add up to the same number. So we have $33 billion in 
cuts on Medicaid for 4 States and $33 billion in tax cuts for 400 
families.
  If you are within the sound of my voice and you are one of those 400 
families, sorry, but I don't think you deserve a tax cut.
  Here is another way of looking at it. This is the same basic 
information, but now, instead of looking at four States, as we did last 
night--those four States were Alaska, Arkansas, Nevada, and West 
Virginia--where the total Medicaid cut was just below $33 billion, here 
is just one State, the State I represent, Pennsylvania. The cuts over 
time come up to $35 billion. The Senate bill might move that one way or 
the other by a little bit, but basically that is what it is. But we 
still have this number we just referred to--$33 billion in tax cuts for 
the 400 highest income households in the country. Nothing about that is 
fair. In fact, I think that is obscene. There are other words we could 
use, but we shouldn't use those words on this floor. That is obscene.
  In the same bill, they are ripping away Medicaid over time, and, as 
we know from the CBO report we saw last night, the House bill has a 
Medicaid cut of 14 million people losing their Medicaid coverage over 
the course of a decade. In the Senate bill, the number goes up to 15 
million. So 15 million of the 22 million who lose their healthcare 
coverage are from Medicaid.
  As my colleague from New Jersey just outlined, low-income folks, 
folks with disabilities, and folks who need to get into a nursing 
home--that is basically the Medicaid population. They are low-income 
children and adults, adults and children with disabilities, and, of 
course, seniors.
  That is the basic inequity here. I don't think anyone around the 
country, if they were looking at that comparison, would really say that 
is fair. How could that be fair in a healthcare bill, that a small 
group of Americans gets a tax cut?
  By the way, it doesn't end there. It is not just the top 400 
Americans, it is a lot of other people as well. So if you are in any 
way wealthy, this bill is a bonanza for you. This is a once-in-a-
lifetime injection of revenue that you are rarely, if ever, going to 
see. But why should a single family get millions and millions of 
dollars--under this scenario, potentially tens of millions for one 
family--why should they get that kind of a break while others are 
losing their healthcare by way of the Medicaid cuts or otherwise?
  So if we are going to have a real process here that leads to a 
bipartisan conclusion, we have to get serious about the issue of 
healthcare. This is not a serious attempt to change our healthcare 
system for the better. A third-grader could rip healthcare away from a 
lot of people and give away the store to very wealthy people. That is 
an exercise anyone could do. That is simple. But to fix problems in our 
healthcare system, to make sure that if you are living in a rural area 
and there is only one insurer, that we work to create some 
competition--to fix that requires some work. To fix that requires 
bipartisan support. It is not this exercise we have been going through 
so far.
  I hope folks on the other side can defend this and go home and say: I 
voted for this bill--or the updated version of the bill in a couple of 
days or weeks--and I am here to tell you that I not only voted for the 
bill, but I am asserting that it is fair to give $33 billion to 400 
households and tear $35 billion out of the Medicaid Program just for 
Pennsylvania--just for Pennsylvania, one State, and it gets worse when 
you add other States.
  I know our time is short and others are waiting to speak, but we have 
a long way to go to make sure we are focused on some of the real 
challenges we have in our healthcare system, not just ripping coverage 
away from vulnerable Americans in order to enrich people who need no 
help, need no injection of a tax cut.

[[Page S3792]]

  In fact, they don't even want the tax cut. I was at a townhall the 
other day, and a doctor stood up and said--if the House version of the 
healthcare bill went through, this one doctor in Pennsylvania would get 
$20,000 in a tax cut. He said: I don't need that. I don't want it. We 
want to fix the system. We want to make sure the people on Medicaid 
still get coverage.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. WYDEN. To wrap this up, Mr. President, I was struck when Senator 
Menendez talked about the Senate Republican health bill being more for 
less. I think millions of Americans might say it is a classic bait-and-
switch. After the horrible House bill was passed, Senate Republicans 
and the Trump administration promised something new. It would have more 
heart. It would be less mean. But essentially what they have done is 
doubled down on exactly what the American people rejected in the House 
bill--the secrecy, the fact that the breaks went to the fortunate few 
and the pain went to millions of Americans who needed nursing home 
care, who have youngsters with special needs, or who are disabled.
  The fact is that the process Senate Republicans have used on this 
health reconciliation bill hasn't gone well. That is why they can't go 
forward with consideration of their healthcare bill this week. And it 
looks as though--I heard remarks from one of our senior colleagues 
early this afternoon--it looks as though the same darn thing is going 
to be used for tax reform. Once again, a bill processed behind closed 
doors, without any input from the other party--it looks as if that is 
the route that is going to be taken on tax reform. I think that is 
unfortunate.
  I have made it very clear--very clear--to the Trump administration 
that the history of successful tax reform is bringing both sides in 
early and finding ways to secure principles that each side feels 
strongly about that the other can live with. There has been no such 
consultation--zero--with respect to this administration and Democrats 
on the Finance Committee.
  I am struck, because I wrote, over the last decade, what are the only 
two bipartisan Federal comprehensive tax reform bills--first with our 
former colleague, the distinguished Senator from New Hampshire, Senator 
Gregg, and most recently with the new head of the Office of the 
Director of National Intelligence, Senator Coats, and we have had no 
consultation on the substance of tax reform. That is a prescription for 
trouble. It is, in effect, walking away from the history that the only 
way to get a sustainable, bipartisan tax reform plan is to get both 
sides together, not do what is being discussed now openly in the media: 
that the Republican leadership and the Trump administration are going 
to write a tax bill and then just pop it on the American people in the 
fall. And I anticipate it will be more of the same in terms of stacking 
the deck dramatically in favor of the fortunate few.
  I say this because we heard again what appears to be the plan of the 
Senate Republicans to kind of double down on the flawed strategy of 
healthcare, which is just to do it in secret and then expect to see if 
maybe they can get a couple of Democrats to go along. Then they can 
say: Oh, that is a bipartisan bill.
  That is not a bipartisan bill.
  A bipartisan bill is the kind of work that was done in 1986 with my 
predecessor, Senator Packwood, and Bill Bradley of New Jersey, who was 
another tall Democrat on the Finance Committee. A big group got 
together and worked out a bill that made sense, broadened the tax base, 
and gave everybody in America the chance to get ahead.
  My hope is that over the next 2 weeks, in terms of defeating a flawed 
healthcare bill and showing that there needs to be a different path for 
tax reform, the American people will keep making those calls, keep 
tweeting, keep texting, keep going to rallies, keep going to meetings 
where healthcare providers get together and say: Look, this healthcare 
bill that Republicans are talking about does not work for us, and it 
does not work for our parents and our grandparents and youngsters and 
the disabled folks and those who need opioid services.
  Again, I thank my colleagues from the Finance Committee. We have had 
something like eight colleagues participate in this over the last hour.
  I would just say to the American people that the reason we have been 
able to hold off this horrendous Senate Republican healthcare bill is 
that grassroots America showed again that political change does not 
start at the top and trickle down but comes from the bottom-up. It was 
all of that citizen involvement that caused the Republican leadership 
to put this bill off, but it is a lock--an absolute lock--that it is 
going to come up again in a couple of weeks.
  As I wrap up my remarks this afternoon, I hope that over the next 2 
weeks, the American people will be loud, will come out to their elected 
officials' events, and will tell them what they are for and what they 
are against.
  On behalf of the Senate Finance Democrats, I yield the floor.
  The PRESIDING OFFICER. The Senator from Washington.
  Mrs. MURRAY. Mr. President, before I begin, I want to make something 
absolutely clear. This healthcare fight is anything but over. TrumpCare 
is not dead--not even close--and we cannot let up. It is no surprise 
that Senate Republicans needed another week to try to jam their 
TrumpCare bill through, given everything it would mean for families' 
health, their financial security, and their lives.
  So, while we do not know what kind of backroom deals the Senate 
Republicans will cut or which Republicans will decide that they care 
more about toeing the party line than protecting the patients and 
families in their States, here is what we do know. The majority leader 
is not going to give up. He wants to get to yes, and so does President 
Trump, so the backroom deals and arm-twisting are going to go into 
overdrive starting now.
  That is why my message is, to every patient and family, every mom and 
dad, adult caregiver, doctor, nurse, teacher, anyone who believes 
TrumpCare would be devastating for their communities: Do not let up the 
pressure. We saw what happened in the House. We need to keep fighting, 
and Democrats are going to keep fighting along with all of you.
  One has to ask, given how mean this bill is and how clearly patients 
and families are rejecting it, why are my Republican colleagues pushing 
ahead?
  It is not like this is some kind of forgone conclusion. At any 
moment, Republicans can drop this effort and work with Democrats on 
healthcare policies that will actually help patients and families and 
not hurt them. Yet it is clear right now that Republican leaders are 
not interested. In fact, they have done just about everything possible 
to prevent not just Democrats but anyone, including most of their own 
party, from being involved in this process.
  As Democrats have made clear, this is unprecedented. I was here when 
the Affordable Care Act was debated and passed. We organized dozens of 
bipartisan meetings. We held hearings, and we took amendments from both 
sides. We certainly did not leave the fate of women's healthcare up to 
a few men.
  Yet, with the Republican's TrumpCare plan, there have been no 
hearings, and there has been no scrutiny, no public input, no expert 
testimony. Why is that? It is that their bill is not actually about 
healthcare--far from it. Their bill is about giving a massive gift to 
the wealthy and the already well-connected on the backs of children, 
working families, the sick, and the elderly. It is an enormous broken 
promise, and yesterday's CBO report made that alarmingly clear.
  Republican leaders promised to lower healthcare costs. This plan will 
actually raise them, especially for seniors. They promised not to pull 
the rug out from under patients, but this plan would take coverage from 
24 million people and gut Medicaid with even deeper cuts, by the way, 
than would the House's version. Under their bill, they said no one 
would be worse off. Tell that to a woman who would have to pay as much 
as $1,000 extra for maternity care or who would have to see her local 
Planned Parenthood center closed. They said their bill would protect 
patients who have preexisting conditions. Read the fine print. The fine 
print says, this plan is a backdoor way of putting those patients' 
fates in the hands of the insurance companies.

[[Page S3793]]

  This is truly shameful.
  Republican leaders promised they were committed to tackling our 
growing opioid epidemic, but with this plan, all of our efforts--all of 
the work left to be done by the States--would be at risk. That would be 
incredibly harmful.
  Over the past year, I have met so many families in my home State of 
Washington who have lost a loved one to the opioid crisis--in 
Bellingham, in Spokane, in Yakima, in the Tri-Cities--in community 
after community. I know the same stories are actually being told in 
West Virginia, in Ohio, in Kentucky, and in Pennsylvania--in States all 
across our country. I have heard directly from people who are on the 
path to recovery who have told me how their getting treatment and 
Medicaid coverage changed their lives for the better.
  What will they do under TrumpCare?
  I would be ashamed, too, if I had to defend this cruel bill over the 
upcoming recess. I would be ashamed if I had to explain this bill to 
constituents of mine like Jennifer England.
  Jennifer is a woman from Kent, WA. She is a mom, a softball coach, 
and a cancer survivor. Because of coverage she had under the Medicaid 
expansion, she decided to play it safe and go to the doctor to get a 
lump checked out, something she told me she would not have done before. 
Jennifer was diagnosed with invasive ductal carcinoma. It was about to 
spread to her lungs and could have been deadly. Jennifer went through 
rounds of chemo and trip after trip to the doctor. On March 8--her 
daughter's 18th birthday--she was finally able to tell her daughter she 
was in the clear. Now Jennifer is terrified of what this bill would 
mean for her finances, for her family, and for her life if her Medicaid 
coverage goes away.
  I would be ashamed if I had to defend this bill to Kelly Hill, from 
Seattle.
  I met Kelly during a recent tour of Seattle's International Community 
Health Services clinic. Kelly shared with me that she has been living 
with HIV for 17 years and has a son with a severe developmental 
disability. Fortunately, Kelly told me she was able to get Medicaid 
when she needed it the most, in graduate school, when she was first 
diagnosed and when she was pregnant with her son.
  Today, her son Avram is 15 years old and cannot be left unattended. 
He is going to need expensive care and support for the rest of his 
life. Medicaid plays a crucial role in keeping Avram active at home, in 
their community, and it allows Kelly the opportunity to have a full-
time job so she can support her family. Kelly knows just how important 
access to healthcare is and the harm and uncertainty TrumpCare will 
cause.
  I want to be very clear. If Republicans jam through TrumpCare this 
month, they will own the consequences. They will have to defend this 
bill to people like Jennifer and Kelly in their own States, and they 
will be responsible for increasing families' healthcare costs, 
undermining protections for people with preexisting conditions, 
defunding Planned Parenthood, and allowing insurance companies to 
charge women more. They will be responsible for taking away care for 
seniors, pregnant women, and people with disabilities.
  Again, Republican leaders can still choose to drop TrumpCare once and 
for all. I am not going to take any chances, though, and neither should 
anyone who is listening who joins Democrats in opposing TrumpCare. I 
fully expect the backroom deals to continue and to get even worse now 
that Republican leaders have been forced to delay this week's vote. I 
just hope the Republicans who are rightly concerned about the impact of 
TrumpCare will take a close look at the facts on the table, will 
recognize it is time to change course, and will stand strong for their 
constituents.
  That is what this debate should be about, making sure the people whom 
we represent can count on the security of healthcare when they get sick 
so they will not have to consider forgoing treatment for a sick child 
because they do not have the money and so they will be treated fairly 
and equally in our healthcare system.
  That is what I have been thinking about these last several weeks. It 
is why Democrats have been holding the floor all of these nights, 
participating in rallies, and staying out on the Capitol steps. It is 
why my friend, the senior Senator from Hawaii, took to the floor 
yesterday and bravely talked about what this fight now means to her 
personally. As she said, everyone is only one diagnosis away from a 
serious illness, and no one should have to worry about what he will do 
if and when that moment comes.
  In this country, healthcare should be a right, not a privilege 
reserved for the few. That is what Democrats are going to keep fighting 
for, and we will not let up.
  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.
  Ms. WARREN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Rubio). Without objection, it is so 
ordered.
  Ms. WARREN. Mr. President, I am deeply relieved that the majority 
leader has delayed a vote on the Republican's cruel bill to rip up 
healthcare for 22 million people. People in Massachusetts and across 
this country spoke out against this terrible bill, and today they 
proved they can make their voices heard. But let's be clear. The 
Republican's so-called healthcare bill has come back to life already 
more times than the scariest zombie in a horror movie. Despite how 
deeply unpopular this bill is and how hurtful it would be to families 
across the country, Senator McConnell says he intends to vote as soon 
as the Senate returns in a little more than a week. That means that 
Senate Republicans still stand on the brink of passing legislation that 
will end health insurance coverage for 22 million people in America.
  Make no mistake, if this plan passes, the rich will get richer and 
other people will die. I know that is a strong statement, and I know 
some people don't want to hear it. I know some people will hear it, but 
they don't want to believe it. But facts matter, and here is the fact 
that Republicans simply want to ignore: People without healthcare 
coverage are more likely to die than people with healthcare coverage. 
For many Americans, health insurance is a matter of life and death. 
Decades of rigorous academic research back this up. The data show that 
people with no health insurance die earlier than those with coverage.
  For example, a 2009 study published in the American Journal of Public 
Health found that uninsured people died at significantly faster rates 
than those with insurance. The authors claimed that lack of health 
insurance was associated with nearly 45,000 American lives lost in just 
1 year. So 45,000 American lives were lost in 1 year. That is more 
people in this country dying for lack of health insurance than from 
breast cancer, and the impact isn't limited to adults. Johns Hopkins 
researchers found that sick kids without insurance who end up in the 
hospital are 60 percent more likely to die than the children down the 
hall who had health insurance.
  In 2012, a study in the New England Journal of Medicine compared 
States that expanded Medicaid, which provided coverage to millions of 
low-income Americans, to those that didn't. They found that for every 
hundred thousand people in States that did not expand Medicaid, nearly 
20 more people die every year than in the States that expanded 
Medicaid. That is right. More people died in States that refused to 
expand Medicaid.
  Now, we know a lot about this in Massachusetts, which has been one of 
the best test cases for understanding how insurance affects death 
rates. We have been working for years--long before the Affordable Care 
Act--to expand health coverage. Today, with the help of the Affordable 
Care Act, more than 97 percent of people in Massachusetts have health 
insurance. That is the highest coverage rate in the entire country.
  Researchers from Harvard and the Urban Institute studied our health 
reforms to figure out the impact of expanding coverage. Their results, 
a 2014 study published in the Annals of Internal Medicine, found that 
Massachusetts health reform was associated with a 4.5-percent drop in 
preventable deaths. These data suggest that, nationwide, the ACA's 
coverage expansions are already preventing 24,000

[[Page S3794]]

deaths a year, and it is in effect in only 31 of the 50 States.
  I could keep going, but the consensus is clear. A new study, hot off 
the press, in the Annals of Internal Medicine put it bluntly: ``The 
case for coverage is strong.'' The reasons are actually pretty 
straightforward. People who don't have access to high-quality, 
affordable care--people who work as hard as they can but just don't 
have the money--can't go to the doctor when they need to; can't get 
preventive care, such as breast cancer screenings and vaccinations; and 
can't fill the prescriptions they need to stay healthy.
  When someone doesn't have coverage, they typically wait to go to the 
doctor until things get really bad--when the cough turns into a rattle, 
when the lump gets too scary to ignore or the backache makes it 
impossible to even to walk. This is the reason why everyone who 
actually works in healthcare--doctors, nurses, hospitals, patient 
groups, researchers, experts--is coming out against the Republican 
bill.
  The American Medical Association--the nation's largest association of 
doctors--says that the Republican bill violates the most basic 
principle of medicine: ``First, do no harm.''
  The National Council for Behavioral Health, whose 2,900 member 
organizations provide mental healthcare and addiction treatment to 10 
million Americans, said the bill would ``cost hundreds of thousands of 
lives.''
  National Nurses United, representing 150,000 registered nurses across 
the country, said the bill would ``prove to be deadly for our nation's 
seniors.''
  The President of a leading coalition of safety-net hospitals said 
about the Republican bill: ``Let's not mince words. . . . People will 
die.''
  If the Republican bill passes, ``people will die.'' That is what the 
healthcare professionals are telling us. The Republican plan is to kick 
22 million people off their health insurance. They want to slash tax 
credits that help people afford their premiums. They want to open the 
door to insurance companies to offer plans with higher costs and less 
coverage.
  And why? Nothing in this bill--not one thing--improves healthcare for 
anyone--not one thing. No, the only reason for this bill is to finance 
$569 billion in tax cuts for a handful of millionaires and 
billionaires.
  There has been a lot of concern about the discussion of healthcare 
getting overheated. The facts do not lie. The academic studies don't 
mince words. If the Republican healthcare bill passes, tens of 
thousands of people in this country will die every year.
  Republicans can ignore these facts. They can turn away from these 
studies. They can pretend they don't know what is going on. But the 
people who lose their healthcare--the babies, the women, the seniors in 
nursing homes, the people with disabilities, the workers who get hurt 
on the job, the people who get hit by heart attacks and strokes and 
diabetes--will suffer all the same.
  Yes, if the Republicans go forward with their bill, people will die. 
Those are the facts. We have less than 2 weeks to make sure the 
Republicans hear from everyone in this country who wants them to 
abandon this terrible bill once and for all.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Rhode Island.
  Mr. WHITEHOUSE. Mr. President, I ask unanimous consent to speak for 
up to 15 minutes in morning business.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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