[Congressional Record Volume 163, Number 112 (Thursday, June 29, 2017)]
[Senate]
[Pages S3842-S3844]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                         Healthcare Legislation

  Ms. HEITKAMP. Mr. President, Congress and our country desperately 
need to have an honest, meaningful, transparent, and bipartisan 
conversation about improving our healthcare system. It shouldn't be a 
tall order, but around here things that seem common sense to the rest 
of the country are never simple. Instead, partisanship too often wins. 
We have seen that with the Senate Republican healthcare bill, as it was 
crafted behind closed doors without allowing any Democrats or the 
public to see it until it was a proposal.
  It is good news that a vote on the bill was delayed, but we must 
continue to have this conversation as the debate continues. That bill 
was bad for North Dakota. Only when we seek real bipartisan solutions 
do I believe we will be successful in improving our healthcare system.
  We need to reform our healthcare system. I have been saying it for 
years. In fact, I have proposed a number of fixes over the past 3\1/2\ 
years, but none of those fixes are embodied in the Republican 
healthcare bill. It is just not the right direction.
  Just yesterday, I joined many of my colleagues to bring up some 
commonsense bills we can and should take up right now to make sure 
American families aren't hurt in the near term. We called on 
Republicans to work with us, but, unfortunately, they objected. I want 
to work in a bipartisan way. I want real healthcare reform. But, 
unfortunately, I do not believe everyone in Congress feels that way.
  First, we need to talk about the facts of the Senate Republican 
bill--facts that are from very reputable nonpartisan sources.
  Earlier this week, the Congressional Budget Office issued a report 
reinforcing that the Senate Republican bill is just as terrible as the 
bill that came out of the House of Representatives a

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few months ago. The Senate bill would rip away health insurance from 22 
million Americans by 2026, including 31,000 North Dakotans who would 
lose private health coverage. You can't put a few bandaids on a bad 
bill and expect that North Dakota would not feel that pain.
  Just as in the House bill, the biggest savings would come from severe 
cuts to Medicaid--a program that would see a 26-percent cut in 2026. 
The bill would slash a lifesaving program that 90,000 North Dakota 
children, individuals with disabilities, seniors, and low-income 
families rely on for affordable, quality care. That includes 36,000 
children in my State.
  The Senate Republican healthcare bill would get rid of the Medicaid 
expansion and cap the amount of Federal funding States can get to cover 
those traditional Medicaid patients. That would drastically reduce the 
amount of Medicaid funds going to the States. This would push those 
remaining costs onto States and counties that can't afford it. 
Importantly, it also would push the cost onto other patients. The 
American Hospital Association estimates that North Dakota Medicaid 
would lose $1.2 billion through 2026. At the same time, North Dakota 
forecasts a $46 million shortfall for 2015 through 2017--that is our 
biennial period--and another $103 million shortfall for 2017 through 
2018. You tell me how our State would pick up these extra costs for our 
families and our children. Unfortunately, we just will not be able to 
do it. We would be forced to discontinue care. That is just wrong.
  Those Medicaid cuts would also imperil rural hospitals, which have 
seen their amount of bad debt fall by 45 percent because of Medicaid 
expansion. Helping those rural hospitals keep their doors open and 
deliver care close to home for farmers, ranchers, and communities is 
absolutely vital to rural development and vital to those people who are 
still working in rural America to put food on our table.
  Additionally, the North Dakota Hospital Association released a study 
showing that healthcare and social assistance accounts for one of every 
seven workers in this State. I am going to repeat that: Healthcare and 
social assistance accounts for one of every seven workers in our State. 
Spending reductions under this Senate bill would curtail those jobs, 
hurt economic development--especially in rural communities--and make 
delivery of healthcare even more expensive for our rural families.
  The cuts to Medicaid would take away coverage from many North 
Dakotans who are also seeking treatment for opioid abuse and addiction, 
which has reached an epidemic level in our State, as well as across the 
Nation. In fact, I had one North Dakota healthcare provider who was 
looking at providing additional behavior and mental health services. In 
the traditional hospital setting, about 14 to 15 percent of the 
patients are on Medicaid. He believes that once this hospital opens, 
anywhere from 60 to 70 percent of the patients will be dependent on 
Medicaid funding for their healthcare. If that money is not there, if 
there is no reliability about that money, how do we build the treatment 
services we need to attack this epidemic?

  I want to dispel a myth about Medicaid, and that is that these are 
just people who can go to work every day, that they are not even 
working, that they are just on the public dole, and that they are just 
getting this money. The truth is that in North Dakota 83 percent of 
adult Medicaid enrollees are in families with a worker. That is a 
statistic according to the nonpartisan Kaiser Family Foundation.
  For North Dakotans who get coverage on the individual marketplace, 
this bill would raise premiums 76 percent higher than what would be 
required to be paid under the current law. That statistic, again, is 
according to Kaiser Family Foundation. Seniors would be especially hard 
hit, with premiums more than doubling for those older than 55. The bill 
would disproportionately push the costs on to older Americans, who tend 
to live in rural communities, like all of those across North Dakota.
  Under the Senate bill, in 2026 a 64-year-old with an income of 
$56,800 would pay annually $20,500 for a silver-level healthcare 
insurance plan. That is more than one-third of his or her entire 
income, and that is more than eight times what the same person would 
pay under the current law, which is $6,800.
  The bill would also enable insurance companies to impose lifetime 
maximums on coverage, once again, making it unaffordable for many 
people with life-threatening or long-term illnesses or disorders to get 
the treatment they need to live by.
  This bill is a not so thinly veiled attempt to provide tax cuts for 
the wealthiest individuals at the expense of rural communities, like 
those across our State. Nearly 45 percent of the tax cuts in the Senate 
bill would go to the top 1 percent of incomes, those people making over 
$875,000 a year. I will say that again. Nearly 45 percent of the tax 
cuts in the Senate bill would go to the top 1 percent of incomes, those 
making over $875,000 a year, according to the Tax Policy Center.
  But what is more telling about these striking statistics is the 
stories. I have heard from so many North Dakotans about how scared they 
are that this bill could pass and how it would hurt them if it ever 
happened. I have heard from North Dakotans with preexisting conditions, 
like cancer or asthma, parents of children with disabilities on 
Medicaid, adults with elderly patients in nursing homes, farmers and 
those in rural communities who rely on rural hospitals, and those 
receiving treatment for opioid abuse.
  The consequences of this bill for North Dakotans are real. I want to 
tell some of those very real stories across my State, because way too 
often we forget this is an issue that could not be more personal.
  I want to introduce you to Allison and Jennifer Restemayer. This is 
her wonderful family. This is Allison here. Allison, from West Fargo, 
was almost 2 years old when she was diagnosed with a rare genetic 
disease. Allison's parents were told she would become severely mentally 
delayed by age 3, and she would likely pass away by the time she was 10 
years old. I am so proud to tell you and so glad to tell you that this 
prediction did not come true.
  Over the past several years, Allison has been able to get new, very 
expensive therapy that helps slow the progression of her disorder. 
Because there are currently no lifetime limits on coverage, Allison's 
family has been able to afford this treatment. Today, Allison is 16 
years old. Allison needs physical therapy multiple times per week to 
truly make a difference in her life day to day and to help her live 
longer. Her private insurance covers just 12 physical therapy 
appointments per year. Allison is one of many children with 
disabilities or special needs on Medicaid, which covers the rest of her 
physical therapy.
  For her and her family--you can see them here--who are so proud of 
the courage of Allison, it has been a lifeline, and it has been a 
lifegiver. But the Republican bill would enable insurance companies to 
impose lifetime maximums on coverage, which many North Dakotans, like 
Allison, would reach in no time. It would slash Medicaid--both 
expansion and traditional Medicaid--making it harder for families like 
Allison's to afford coverage and critical treatment for their children 
with special needs. The Restemayers should never ever have to worry.

  I have spent a lot of time with Allison, and I think anyone who meets 
her knows that this world is a much better place with Allison healthy 
and alive. We are so proud to call her one of our friends. She has been 
an inspiration to me and my staff. She has participated in a lot of 
dialogues, and her advocacy has been absolutely instrumental in telling 
the story of families like hers in North Dakota.
  I want to talk about Emerie and Amy Thom. At just 2 months old, 
Emerie, from Bismarck, had her first set of seizures and was diagnosed 
with a rare neurological condition. Her parents, Amy and Johnny, have 
crisscrossed North Dakota and visited many hospitals out of State to 
get Emerie the care she needs and to control her life-threatening 
seizures.
  Emerie is now almost 4 years old and has spent a total of 8 weeks in 
the hospital since she was born. She receives therapy multiple times 
per week and needs various medical equipment. Just 1 month of therapy 
out-of-pocket would cost her family--good, hard-working people--$3,000. 
Emerie is on

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Medicaid, which has enabled her family to afford her hospital stays, 
her home healthcare, and her therapy. It has also enabled them to keep 
their daughter home with them in a loving family relationship, in a 
lovely family situation.
  It is because of the access to Medicaid that this family has been 
able to stay in their home and keep their jobs, but the Senate 
Republican healthcare bill would rip Medicaid away from families like 
Emerie's. This family does not deserve that, and neither does any 
family who is working hard to take care of their children. These are 
all of our children, the children we see today who suffer from 
disabilities, who live and inspire us with their disabilities and their 
hope. This small help these families ask for from the Medicaid system 
should not be threatened, and these families should not be calling 
congressional offices begging us to please, please do everything we 
can.
  Finally, I want to talk about Frances. Frances is one of the nicest 
people you are ever going to meet. For 25 years, she was a third grade 
teacher in Fessenden. When she was 21 years old, while she was 
teaching, she was diagnosed with a syndrome that affects the nerve 
endings in her body. She became paralyzed but taught herself to walk 
again. For the rest of her life, she will have to face the challenges 
that come with this disorder. Today, Fran can't walk anymore, and she 
has been in a wheelchair for the past 24 years.
  For most of her life, Fran lived independently with her husband, who 
passed away in 2000. In the past few years, she has reached a point 
where she needs full-time care. She is now 84 years old. She lives in a 
nursing home in Harvey, and she has been there for 4 years. Fran had 
been in and out of nursing homes a few times beforehand, all which 
required private pay. Because of the extreme costs, Fran doesn't have 
any money or savings left. She spent it all on her healthcare.
  Now she is one of many seniors on Medicaid, which enables her to 
afford the quality, long-term care she needs to live with dignity and 
support. At the nursing home, she gets extensive assistance with 
bathing, dressing, and doing any activities. Fran doesn't know what she 
would do without Medicaid. She doesn't have any children to help her. 
Her siblings are all older than she is, and they wouldn't be able to 
provide her with the level of care she needs. If it weren't for 
Medicaid, Fran would be out of options.
  The Senate Republican bill threatens the coverage that Fran has and 
that so many others rely on. You know what, we cannot let that happen.
  This issue has many faces. These are just three North Dakota faces I 
want to talk to you about. These families aren't interested in 
politics. They couldn't care less about politics. They want the ability 
to take care of themselves. There is no guilt to any of these 
conditions. There is no ``you did it to yourself'' to any of these 
conditions. This is the human condition.
  We have to decide as a country, are we together in taking care of 
each other, or are we all on our own? That is the issue. How do we take 
care of the sickest among us? Are we together, or are we on our own? I 
believe we are stronger when we stand together to provide care to each 
other and to those who are not as fortunate.
  I was talking to some of the families. It is hard when you are a mom, 
I think, to think about, well, what was your life with your child 
growing up? I had two children, born extraordinarily healthy. They 
barely missed a day of school, they were so healthy. They had an 
opportunity to engage in every level of activity, giving me and my 
husband the freedom to pursue other things in our lives. That is a 
gift. It is also a gift that we as a society can help those who don't 
have that level of good fortune but have children who need some special 
attention, children whose care you cannot afford on your own.
  From the discussions I have had with so many of the families, very 
few of us could ever afford the medications and the therapies that 
guarantee quality of life not only for the child but for the family in 
terms of respite care.
  Allison, Emerie, and Fran, we are going to keep talking about this, 
and we are going to keep evaluating all of the proposals that come our 
way. When they don't do right by you, Emerie, Allison, and Fran, when 
it is not the right solution for your family, it is not the right 
solution for North Dakota, and it is not the right solution for this 
country. We have work to do.
  I know the Presiding Officer has been one of the leaders in analyzing 
and reviewing these bills. We have had a chance to have some 
discussions. I hope we will have further discussions about how we can 
continue to care for these wonderful North Dakotans.
  The Presiding Officer knows story after story, having been a 
physician. Being a physician, my husband can tell you story after story 
about people who are challenged. In this system of healthcare, we all 
have to decide whether we stand alone or together. I believe America is 
stronger when we stand together and help each other.
  With that, 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. CORNYN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.