[Congressional Record Volume 163, Number 116 (Tuesday, July 11, 2017)]
[Senate]
[Pages S3926-S3931]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                         HEALTHCARE LEGISLATION

  Mr. BLUMENTHAL. Mr. President, I come to the floor today after a 
fourth field hearing in Connecticut. Every one of those field hearings 
has been packed. I spent time at a Planned Parenthood clinic in 
Hartford, as well as having visited others over the past year. I have 
spent time with numerous providers and at community health centers and 
heard firsthand from the people of Connecticut as to why the Republican 
health bill, which has been unveiled after having been concocted behind 
closed doors, would devastate the health and finances of Connecticut's 
families and their communities.
  The bill that we expect to be disclosed later this week will almost 
certainly be defective in the same ways as the bills that we have seen. 
To call these proposals mean or heartless, as the President has, is a 
gross understatement. The bill, very simply put, would cost both 
dollars and lives, eroding not just our ability to save money by 
investing in a healthier future but causing death and despair when 
neither term is really necessary. This wound would be self-inflicted, 
but it is a wound that is preventable and avoidable.
  I pledge to the people of Connecticut that I will fight as long and 
as hard as necessary to stop this grotesquely cruel and costly 
proposal.
  It is not, in fact, a healthcare bill. It is a wealth care bill. It 
decimates Medicaid, saving, supposedly, close to $1 billion so that 
those savings can be used for tax cuts for the wealthiest Americans. As 
Warren Buffett has said--and he is one of them--``I don't need it.'' He 
would rather see it be used for better healthcare and coverage, and 
that is what the majority of Americans want. That is why this proposal 
is so deeply unpopular.
  Now, after weeks of secrecy, followed by chaos, we are back to 
secrecy again, with Republicans retreating away from their constituents 
and going behind closed doors. Even over this past week, when we were 
back in our home States, they were crafting another bill. We have not 
seen it. We have not debated it. We cannot even say that we know 
anything about what is in it, and my Republican colleagues know little 
more than we do on this side of the aisle. We know for sure, despite 
the secrecy, that the devastating effect would be overwhelming on 
people across income strata, geographic boundaries, and cultural 
backgrounds.
  I am here not to talk in abstractions. I am here to talk about real 
people in real life and to share the stories that I heard at these 
field hearings--people's stories that they have entrusted me to bring 
to you. Many of my colleagues have refused to hear these stories from 
their constituents because they would hear how repugnant and repulsive 
this bill is and how deeply angry the people of the country are. The 
people of Connecticut and the country are outraged.
  The reason is people like Ariella Botts, and here she is. Ariella is 
4 years old. She came to my field hearing last week with her mom, 
Rachel. Ariella, as her mom told me, has nemaline myopathy, which is a 
rare form of muscular dystrophy. Their family relies on Medicaid for 
her care. I want to tell you exactly what Rachel said about Ariella and 
their family, because her words are far more eloquent and powerful than 
mine.
  Rachel said:

       The fact of the matter is that my daughter's care would 
     cost over $20,000 a month out of pocket between her food, her 
     medication, her care, and the breathing machines that keep 
     her lungs clear. There is no average American family that can 
     pay $20,000 a month of medical costs. We do our part. We have 
     two jobs a piece. We do everything we can do. This is the 
     only thing we ask for help on.

  Rachel went on to say:

       Supporters of the Trumpcare bill want you to believe that 
     costs are high because there is this nameless and faceless 
     abuser of the system, but I have spent hours in the waiting 
     rooms of Yale New Haven Hospital and Connecticut Children's 
     Medical Center. I have spent hours in the neonatal intensive 
     care units and the emergency rooms, and I can tell you that 
     the people who are accessing care on my level--they're not 
     abusers.

  I am going to continue quoting Rachel. I cannot really speak with the 
same power and authenticity that she has, but we are not allowed to 
show videos here on the floor.
  She continued:

       We're mothers and fathers who know that there's more for 
     our children to achieve. We're tax-paying, community-
     investing, voting, involved warriors for our families.

  I asked Rachel what would happen to her family if Ariella did not 
have Medicaid, and Rachel said: ``It would bankrupt us in less than a 
month.''
  I want to tell you what it is like to spend just a little bit of time 
with Ariella. She is the most vivacious, animated, beautiful girl, and 
you would not know anything about her condition but for this apparatus, 
which is there so she can lead a normal or a near normal life and be 
the wonderful young lady that she is. I smile when I think of

[[Page S3927]]

her at this hearing because she brought smiles to all of our faces. I 
understand the joy and pride that she brings to her family because she 
is one courageous, strong child, and we are proud of her.
  Rachel and Ariella were not the only people I heard from whose lives 
have been made not just better but, truly, whose lives have been made 
possible by Medicaid.
  Jeff Pabon was also at a hearing that I held, and he told me about 
his family when he was growing up. As a single mother, his mom raised 
him and his four siblings. As a member of the working class, Jeff told 
me ``she needed as much assistance from the system as the system could 
provide.'' Years later, as an adult, Jeff proudly served our country in 
the U.S. Navy during Operation Desert Storm. He now has a family of his 
own, including a son with autism. He spoke out at my hearing because, 
as he said, ``I've fought for this country before.''
  What Jeff told me touches the core--the heart--of this debate, and I 
want to read it here on the Senate floor because he said it so 
powerfully:

       The healthcare bill being crafted in secrecy by a minority 
     of Republican Senators now threatens Medicaid protections and 
     aims to provide tax breaks for the ultra wealthy, top 1 
     percent of America. I would like to see sensible, bipartisan 
     legislation which serves the majority of Americans, like the 
     other 99 percent. Let's repair the provisions of the 
     Affordable Care Act that need reparation. We need to be 
     moving forward, not backward.

  Jeff is right, and so is Rachel. How absurd and reprehensible that 
costs will rise astronomically while Medicaid funding and the number of 
those with insurance coverage will go down, just so our Nation's 
richest can see billions of dollars in tax cuts--laughable, if it were 
not so deadly serious. ``Deadly'' is the word because this bill will 
cost lives. We rarely deal in life and death issues in this Chamber. 
This issue is one of them.
  It will decimate the lives and livelihoods of so many and threaten 
not only Ariella but many like her of all ages--the senior who goes 
into a nursing home after exhausting her life savings and depends on 
Medicaid, the woman who goes to a Planned Parenthood clinic to be 
screened for cancer and finds that this pernicious disease has been 
detected because of that preventive step and the availability of 
healthcare at Planned Parenthood, the opioid addict who suffers from 
that disorder or disease--it is a disease, not a moral failing--and 
seeks recovery through the medicine that is made available by Medicaid. 
Forty-four percent of all of the medication for opioid addiction 
treatment comes from Medicaid in the State of Connecticut. All of them 
are at risk. It is not just their convenience or their comfort. Their 
lives are at risk.
  I heard their stories, and I am haunted by them. I can hear their 
voices, and I can see their faces. I want my colleagues to do the same. 
I am ready to do what Jeff asked of me. I am ready to work with all of 
my colleagues--Democrat and Republican--to move us forward, not 
backward. Let's work together in a bipartisan way to fix the parts of 
our healthcare insurance system that need repair. Let's go forward, not 
backward.
  I am eager for the call from my colleagues on the other side of the 
aisle that offers solutions--not repeal but real solutions--as to what 
the American people need, want, and deserve.
  First, we must bury the efforts to decimate Medicaid, to defund 
Planned Parenthood, and to repeal the Affordable Care Act. We have a 
chance right now to improve healthcare--a moment, an historic 
opportunity--and we must seize it. I feel that we are on the cusp of 
that dramatic and historic moment, and I look forward to working with 
my colleagues across the aisle.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Lankford). The Senator from Vermont.
  Mr. SANDERS. Mr. President, let me be as clear as I can be. The so-
called healthcare bill that passed in the House of Representatives 
several months ago, strongly supported by President Trump, is the most 
anti-working-class legislation that I have ever seen. The Senate bill, 
also supported by Mr. Trump, in some respects is even worse.
  At a time when working families in Vermont and all across this 
country are working longer hours for low wages--many people in my own 
State are working two or three jobs just to bring in enough income to 
maintain a family--this legislation will cause devastating harm to 
millions of our families from one end of America to the other.
  The American people are united. This weekend I was in West Virginia 
and Kentucky--so-called conservative States--but I tell you that what 
is true there, what is true in Vermont, and what is true all over this 
country is that the American people are standing up and saying loudly 
and clearly that we will not allow 22 million Americans to be thrown 
off of the health insurance they currently have in order to give over 
$500 billion in tax breaks to the wealthiest 2 percent, to the drug 
companies, to the insurance companies, and to other profitable 
corporations. We will not support a bill that takes from the most 
vulnerable people in our country--the children, the elderly, the 
disabled, the sick, and the poor--in order to make the very, very rich 
even richer. This is unconscionable, un-American, and the American 
people will not accept it.
  Plainly stated, this so-called healthcare bill is really nothing more 
than a massive transfer of wealth from the working families of this 
country to the very rich. While this bill contains massive cuts to 
Medicaid; while seniors will pay far, far more in premiums; while 
Planned Parenthood will be defunded, the 400 highest income taxpayers, 
most of whom are billionaires, will get about $33 billion in tax cuts.

  There is no State in this country--none, not the most conservative--
that thinks that you throw 22 million people off of health insurance, 
including disabled children, in order to give $33 billion in tax breaks 
to the wealthiest 400 Americans. At a time when so many people in 
America are struggling, the very wealthy are already doing phenomenally 
well. They do not need more tax breaks.
  Not only is this bill a disaster, but the secretive, backroom process 
by which it has been written is unprecedented and literally beyond 
belief. That is not just me speaking; I think a number of my Republican 
colleagues who disagree with me on everything make that point as well. 
This bill impacts one-sixth of our economy--over $3 trillion--and by 
definition, dealing with healthcare, it impacts virtually every 
American. Yet the discussions and negotiations on this legislation have 
never been made public. In fact, I suspect they are going on right 
now--not here on the floor but behind closed doors.
  Unbelievably, with legislation that would completely revamp our 
healthcare system, there have been no doctors, no nurses, no hospital 
administrators, no representatives of senior citizens, no experts on 
the opioid crisis--which is sweeping our country--who have testified in 
public about the impact this legislation will have in our country. How 
can one possibly dream of drafting a bill of such enormous magnitude 
without hearing one public comment from the most knowledgeable people 
in America with regard to healthcare?
  How can you possibly go forward without one public hearing where 
Senators have the opportunity--Democrats, progressives, Independents--
to ask questions? But that is precisely the process this legislation 
has gone through.
  I fully understand there are a lot of people who will say: Well, big 
surprise, Bernie Sanders, a strong progressive, opposes this Republican 
bill. What else is new?
  But I want you all to understand that it is not just Bernie Sanders 
or Democrats here who oppose this legislation; this legislation is 
opposed by virtually every major healthcare organization in the United 
States.
  I am not quite sure how we can go forward with major legislation 
impacting one-sixth of the economy, opposed by every major healthcare 
organization in the country, and not have one hearing. I am not quite 
sure how that can be done, but that is precisely what the Republican 
leadership here is doing.
  It is not just Bernie Sanders who opposes this legislation. It is the 
AARP, which is the largest senior group in America. It is the American 
Medical Association. Hey, those are our doctors. When you get sick, you 
go

[[Page S3928]]

to a doctor. Many of them are members of the American Medical 
Association. They say this bill is a disaster. It is not just doctors. 
It is nurses. It is hospital administrators. It is the American Cancer 
Society, the American Heart Association, the American Academy of Family 
Physicians, the American Academy of Pediatrics, the American 
Psychiatric Association, the Federation of American Hospitals, the 
Catholic Health Association, the American Lung Association, the Cystic 
Fibrosis Foundation, the March of Dimes, the National MS Society, and 
the American Nurses Association, among many other organizations that 
oppose this bill being written behind closed doors.
  Several months ago, as I think everybody knows, with the strong 
support of President Trump, the House passed their disastrous 
healthcare bill. Now, we know what is in the House bill. The Senate 
bill probably is being worked on as we speak, so we don't know what is 
in that exactly, but let me tell my colleagues what the House bill 
does. At a time when 28 million Americans today--before the Republican 
bill--have no health insurance and millions more are underinsured, with 
high deductibles and copayments, this bill from the House will throw 
another 23 million Americans off of the health insurance they currently 
have.
  Think about it. Gee, if we have 28 million Americans off of health 
insurance, what most Americans would say is: OK, how do we lower that 
number? In fact, the Affordable Care Act added another 20 million 
people to the ranks of the insured. This bill throws 23 million on top 
of the 28 million we currently have uninsured, almost doubling the 
uninsured in America to over 50 million people. Think about it. People 
have a hard time even beginning to believe that legislation that is 
being seriously debated would almost double the number of uninsured in 
America.
  Everybody understands--there is no debate about this--that the 
Affordable Care Act is far, far from perfect. This is a point I have 
been making from the day the Affordable Care Act was passed. Premiums 
in my State of Vermont and around this country are too high, 
deductibles are too high, copayments are too high, and too many 
Americans remain uninsured or underinsured. But in each and every one 
of these legitimate concerns, the Republican legislation that has been 
brought forward and passed in the House would only make a bad situation 
much worse.
  The Republicans say: Oh, the Affordable Care Act is a bad piece of 
legislation. It has problems. The Affordable Care Act does have 
problems. Their legislation exacerbates every single one of the 
problems that it has.
  So our job today, and I think what the average American understands--
OK, we have problems. What are the problems? We have listened. 
Deductibles are too high. Copayments are too high. Premiums are too 
high. Prescription drug prices are way too high. OK. Let's discuss it. 
What is your idea? How do we deal with these problems? That is what the 
American people want. The American people want us to address 
the problems that are in the Affordable Care Act, not destroy it.

  It seems to me clearly that our job right now--and the American 
people are rising up. They are not going to accept this Republican 
legislation. Together we are going to defeat it.
  I wish to speak for a moment about what it means if this legislation 
were to pass. What are the implications of throwing 22 million people--
that is the Senate bill--off of health insurance, and 23 million people 
in the House bill? Let me tell my colleagues. I want every American to 
think about this. Just think about it. Think about somebody today who 
has cancer and is maybe in chemotherapy or maybe in radiation, somebody 
who has heart disease, somebody who has diabetes or some other life-
threatening disease. There are God knows how many people in this 
country right now who are sick. What happens if they lose their health 
insurance? A simple question. You have cancer, you are getting 
treatment today, and the Republican bill takes away your health 
insurance. What happens to you when you cannot afford to go to the 
doctor when you feel a lump in your breast or when you have problems 
with your heart? What happens to you if you have a heart attack or a 
stroke and need significant care, but you have no health insurance and 
you don't have the money to pay for the outrageously high cost of care?
  Here is the horrible and unspeakable truth that has to be brought out 
into the open; that is, if this legislation were to pass, many 
thousands of our fellow Americans would die, and many more would suffer 
and become much sicker than they should. Now, I am not suggesting that 
there is anybody in this body who wants to see anybody die 
unnecessarily. Nobody does. But people have to take responsibility for 
their actions, and if you throw 23 million people off of health 
insurance, many of whom might have life-threatening illnesses, 
thousands of people will die.
  Several weeks ago I was on a television program, and I said just 
that, and then right after that, I was criticized by Republicans and 
rightwing critics: Why did you say that? What a terrible thing. Why are 
you frightening the American people? ``Some people will die''--that is 
not true.
  Well, PolitiFact is a nonpartisan organization that checks out what 
public officials say, and they took a look at well over 10 different 
studies on the issue of mortality rates and lack of insurance coverage. 
That is what they studied. They looked at more than 10 different 
studies looking at mortality rates and lack of healthcare coverage. 
What PolitiFact concluded is that the point that I made--that many 
thousands will die--is well supported. It is not Bernie Sanders. I am 
not coming up with some idea off the top of my head. This is what many, 
many medical and scientific studies have told us.
  Obviously nobody can predict exactly how many people will die if 23 
million people lose their health coverage, but what experts at the 
Harvard School of Public Health estimate is that if 23 million people 
are thrown off of health insurance, as the House bill does, up to 
28,000 people could die each and every year--28,000 people. That is 
nine times more than the tragic loss of life we suffered on 9/11, and 
that would take place each and every year. In the wealthiest country in 
the history of the world, we must not allow that to happen.
  This bill would impact the children, many of whom are covered by the 
CHIP program, covered by Medicaid. You tell me what happens to a kid 
who has a disability right now and whose family receives Medicaid. Some 
of those children may have Down syndrome. Some of those children may 
have cerebral palsy, muscular dystrophy, maybe autism. They may have 
mental health needs, such as depression or anxiety, or complications 
from premature birth. Today, Medicaid and CHIP cover 5 million--or 44 
percent--of those kids, providing them with coverage so that they can 
live with dignity and security.
  But it is not just the children who will be impacted, it is also the 
elderly. What every person in America should understand--and many do 
not--is that Medicaid now pays for over two-thirds of all nursing home 
care. So I ask my Republican friends: What happens when you slash 
Medicaid? Who will pay for somebody's mom or dad in a nursing home 
dealing with Alzheimer's disease? How many seniors in this nursing home 
will get thrown out on the street or be forced to live in their 
children's basement? Well, we don't know the answer to that. We haven't 
had any hearings. We haven't heard any people testify to that. But I 
think we will see a whole lot of families disrupted, having to make the 
choice about whether to take care of their parents or provide for their 
kid to go to college.
  It is not just nursing home care. What happens if you are just an 
older worker. Maybe you are 60 years of age. Well, the likelihood is 
that if you are a 60-, 62-year-old worker, the cost of your premiums is 
going to soar. Again, this is not Bernie Sanders' view; it is what the 
AARP says.
  This is a quote from the AARP from June 22:

       This new Senate bill was crafted in secrecy behind closed 
     doors without a single hearing or open debate--and it shows. 
     The Senate bill would hit millions of Americans with higher 
     costs and result in less coverage for them.
       AARP is adamantly opposed to the Age Tax, which will allow 
     insurance companies to charge older Americans five times more 
     for coverage than everyone else while reducing tax credits 
     that help make insurance more affordable.

  That is the AARP.
  What about the opioid epidemic, which is hitting my State of Vermont 
hard and hitting States all over this

[[Page S3929]]

country? Each and every day, more than 90 people in America die from an 
opioid overdose. Can you believe that? Ninety people die every single 
day. Nearly 4,000 people begin abusing prescription painkillers, and 
about 600 start using heroin. We have a major, major crisis in opioid 
addiction and heroin overdoses.
  It turns out that if you cut Medicaid by $800 billion, which is what 
the Republicans are talking about, our ability to address the opioid 
crisis will be severely curtailed. At a time when we should be 
expanding prevention efforts, expanding treatment efforts, the 
Republican bill will make it much harder for us to deal with the opioid 
crisis.
  This legislation is not what the American people want. I understand 
that the Republican leader today suggested that Members of the Senate 
may have to stay here for a few more weeks in August, and I can 
understand that. If I were the Republican leader, I would not want my 
Senators to go home to hear what the American people have to say about 
this legislation.
  The truth is, poll after poll shows overwhelming opposition to this 
disastrous legislation. According to the latest USA TODAY/Suffolk 
University Poll, just 12 percent of the American people support the 
Republican bill.
  As a matter of fact, according to a recent report, this is the most 
unpopular piece of legislation in the last three decades. It is more 
unpopular than the $700 billion bailout of Wall Street. That is pretty 
unpopular. The American people are catching on as to what is in this 
bill, and they do not want to see it.
  Let me conclude by saying what is as obvious as can be. It is what 
the American people want. Are there problems with the Affordable Care 
Act? Absolutely. Premiums are too high, deductibles too high, 
copayments too high, prescription drug prices are off the charts.
  Let's deal with it. What is the problem? Let's deal with it. Put it 
on the table, and let us address those problems. The American people 
want to improve the Affordable Care Act, not destroy it.
  Let me now, speaking for myself only, say this. I hope very much 
there can be bipartisan efforts to improve the Affordable Care Act, but 
I happen to believe we have to go further than that. I intend to help 
lead that effort.
  In my view, there is something profoundly wrong when the United 
States of America is the only major country on Earth--the only one--
that doesn't guarantee healthcare to all people as a right, while at 
the same time we spend far more per capita on healthcare. We spend far 
more per capita on prescription drugs, and our healthcare outcomes are 
not particularly good compared to many other countries.
  I think the time is long overdue as to why we do not ask ourselves: 
How is it Canada can guarantee healthcare to all people, the UK can do 
it, Germany can do it, France can do, Scandinavia can do it? Every 
major country on Earth recognizes that healthcare must be a right, not 
a privilege.
  I happen to agree with that. That is why I will--as soon as this 
debate is over and as soon as, hopefully, we defeat this disastrous 
Republican legislation--introduce a Medicare-for-all, single-payer 
bill, which will in fact guarantee healthcare to all of our people in a 
cost-effective way.
  Let me conclude by saying that the current Republican bill in front 
of us is a moral outrage. There are very few people in America who 
think you should throw 22 million of our people off of health insurance 
in order to give huge tax breaks to billionaires. This is a moral 
outrage, and it must be defeated. I will do everything in my power to 
see that it is defeated.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Maryland.
  Mr. VAN HOLLEN. Mr. President, like many of our colleagues during the 
Fourth of July break, I spent much of my time crisscrossing the State 
of Maryland. On the Fourth of July, I attended many parades. The very 
first parade of that day was in a part of Maryland outside of Baltimore 
City, called Dundalk, MD, where Donald Trump had done very well in the 
past election.
  What I found during that parade was a lot of people there who were 
still supportive of President Trump but not one person at that parade 
who was in favor of TrumpCare or the Senate Republican so-called 
healthcare bill--not one.
  I was listening to the Senator from Vermont about the most recent 
polling. The polling I had seen previously had shown 17 percent of the 
American people in favor of this, which was very low. I am not 
surprised to hear it is even lower now at 12 percent because my own 
personal experience in these places in Maryland that had been 
supportive of Donald Trump, and in many ways still are, were that they 
were not in favor of this healthcare bill. In many ways, they had felt 
betrayed by it.
  After all, during the last campaign, Donald Trump said he wasn't 
going to cut Medicaid, and yet the bill before us has dramatic cuts to 
Medicaid. In fact, the Senate bill has even deeper cuts to Medicaid 
over time than the House bill.
  We all remember the House bill. President Trump had a great 
celebration in the Rose Garden in public, but behind closed doors he 
called it mean. Yet the Senate bill, when it comes to Medicaid cuts, 
will make them even deeper over a period of time, according to the 
report issued by the Congressional Budget Office, the nonpartisan 
Congressional Budget Office, just as we all left town for the Fourth of 
July break.
  It was an interesting experience to hear people, on the one hand, 
saying let's find ways to work together on many of the challenges we 
have in this country--and we should find ways to work together--but are 
strongly opposed to the healthcare bill that is before the Senate right 
now. The reason is, they are paying attention. They are concluding 
about this bill the same thing that the AMA, the American Medical 
Association, has concluded. In opposing this bill, America's doctors 
say it violates the No. 1 principle of medicine, which is: First, do no 
harm. That is the Hippocratic Oath. This Senate so-called healthcare 
violates that very simple proposition. At the very least, we want a 
healthcare system that doesn't do greater harm than what would 
otherwise be flawless. Yet we know, from this legislation, in looking 
at it, that it does do great harm to our healthcare system in the 
United States of America.
  The nonpartisan Congressional Budget Office has looked at it and 
concluded that if you pass this legislation, 22 million fewer Americans 
will have access to affordable care than if you don't pass the bill. So 
it does harm compared to where we are today.
  It is absolutely true that the Affordable Care Act is not perfect. In 
fact, the healthcare exchanges specifically can be improved. We need 
more choices. We need more competition there. Make no mistake, the 
Senate Republican bill and the bill that passed the House don't improve 
the Affordable Care Act. They destroy those parts of it that are 
working and have been of great benefit to tens of millions of 
Americans.
  The Congressional Budget Office also tells us that premiums will go 
up next year. The Congressional Budget Office also tells us that if you 
are a senior between the ages of 50 and 64, you are in for a walloping 
increase in your premiums, which of course is what the AARP calls the 
age tax and why they are on the warpath against this legislation--
because it will be greatly damaging to those seniors who are in the 
individual market who are now going to have to pay huge increases in 
premiums. Those have been documented by the nonpartisan Congressional 
Budget Office.
  I would remind my colleagues that the head of the Congressional 
Budget Office was someone selected by the Republican chairman of the 
Senate Budget Committee and the Republican chairman of the House Budget 
Committee, and the CBO is our referee in this place.
  If we all could make up our own facts, which in many cases the 
debates go in those directions anyway, it would be an even more unruly 
place. At least we have the CBO to provide that analysis. It is not 
just the CBO. This is masquerading as a healthcare bill.
  I ask the question of my colleagues, Why is it that every single 
patient advocacy group that has weighed in on this bill has weighed in 
against this bill? These are not Democratic organizations or Republican 
organizations:

[[Page S3930]]

the American Cancer Society, the American Heart Association, the 
American Diabetes Association, the National Association on Mental 
Illness, National Breast Cancer Coalition, the National Multiple 
Sclerosis Society, the Alzheimer's Association. These are our 
constituents.
  They don't wake up every morning thinking about a Democratic plan or 
Republican plan or Independent plan. These are organizations dedicated 
to patient health. They are all against a bill that is parading as a 
healthcare bill.
  How can that be the case, that every single advocacy group that has 
weighed in on this bill that has a healthcare mandate and is 
nonpartisan is against it?
  I ask my Republican colleagues to go back to the drawing board. This 
is not a healthcare bill, not when every single patient advocacy group 
weighed in against it, not when nonpartisan analysis tells us that 22 
million people will lose out, not when the American Medical Association 
says it violates this simple principle of, first, do not harm.
  It is not just the doctors. It is the nurses. It is the hospitals. It 
is the National Rural Health Association. I spent a good amount of time 
in rural Maryland over the Fourth of July break. Rural hospitals are 
terrified of the consequences of this legislation, not just because of 
the harm that will befall their patients because their patients will be 
denied access to affordable care--but when they no longer have patients 
who are covered by insurance who come through their doors and there is 
an emergency so they provide that care anyway, then the hospital all of 
a sudden is not getting paid for the care it provides. They are deathly 
afraid they are going to have to scale back their operations and lay 
off people in a lot of these rural hospitals.
  I really hope and believe this is a moment where the Senate can look 
at this situation and decide let's not go down this road because the 
American people are asking themselves why are we doing this. It is one 
of those cases where I think people sort of lost track of why, other 
than the fact that, as many have said today, there had been this call 
to get rid of ObamaCare, to get rid of the Affordable Care Act but 
never a lot of thought as to what was going to replace it.
  Now what we are learning is the proposals that would supposedly 
replace it will do harm. They will do a lot more harm than the place we 
are at today. Rather than do harm and hurt tens of millions of 
Americans, let's find a way to improve the current system. There are 
practical ideas for how we can improve the healthcare exchanges, the 
marketplaces within the Affordable Care Act. Many of us have put 
forward ideas, and I would be more than happy to explore with our 
colleagues ways we can improve upon those exchanges without doing harm.
  When you look at this legislation and you realize it is not about 
healthcare, you have to ask yourself: What is it about other than 
simply saying we are going to fulfill this pledge of getting rid of the 
Affordable Care Act? At its core, there are two pillars to this bill. 
They are rotten pillars, but that is what they are. One is these very 
dramatic cuts to Medicaid, very dramatic. As I said, the Senate cuts 
even deeper over a longer period of time than the House bill. In the 
Senate bill, that cut is around $770 billion, and then there are also 
cuts to tax credits that help more Americans afford healthcare. So if 
you cut Medicaid, you get rid of tax credits that make healthcare more 
affordable. On the other side of the ledger is this whopping tax cut-- 
whopping tax cut that goes to some very powerful special interests and 
some very wealthy individuals. Many of us heard Warren Buffett a couple 
of weeks ago on TV saying: I don't need a $670,000-a-year tax cut as 
part of a bill that is going to put the health of my fellow Americans 
at risk.

  I think a lot of people are asking the question: If this is a 
healthcare bill, why is the core of it this huge cut to Medicaid and a 
huge tax break for the wealthiest Americans? And by the way, if you 
make $1 million a year, you get a $57,000-a-year, on average, tax break 
in this so-called healthcare bill.
  So let's put aside a bill that is rotten to its core. I heard a lot 
of talk about trying to fix this. I would just warn my colleagues to 
make sure our constituents know that cosmetic changes aren't going to 
fix this. You can't put a little deodorant on this and make it come out 
smelling great. It is just not going to happen. But if people are 
genuinely interested in finding ways to improve the exchanges, I am all 
in. We certainly should work together to reduce the cost of 
prescription drugs, and there are lots of proposals out there to do it. 
The President at one time even talked about making that a priority, but 
that seems to have fallen away. We all know there are ways we can 
smartly save money in our healthcare system by continuing to move away 
from a system that is based simply on the quantity of care and the 
volume of care and move toward one that rewards the value and quality 
of care. Let's do that.
  The final thing I want to point out is that I was in Southern 
Maryland over the break, down in a place called St. Mary's County. I 
visited one of the substance abuse treatment centers called Beacon of 
Hope Recovery Center. These are people of great faith coming together 
to help people who are victims of the opioid epidemic, which has had a 
devastating impact on Maryland, as it has on so much of the rest of the 
country. We talked about some of the former patients who were there, 
people who are now actually part of the operation to help save the 
lives of other people who are racked with addiction. We met with these 
dedicated staff members, former patients, and with local law 
enforcement all around a table, recognizing that if we are really going 
to conquer the opioid epidemic, we need to provide treatment services. 
This recovery center was pleading with all of us--with me, asking me to 
plead with all of our colleagues to not cut Medicaid because they are 
going to be relying on continuing Medicaid funding in order to provide 
those treatment services.
  I think people around the country are just beginning to learn that 
Medicaid has been helpful and will become even more helpful in the 
fight against the opioid epidemic; that it is helping our kids with 
disabilities and special education in our schools; that it helps low-
income working families who may work for an employer who doesn't 
provide health insurance and who still pays so low that they are at an 
income level where they qualify for Medicaid. People are also learning 
that most of the money spent in Medicaid goes to individuals in nursing 
homes and people with long-term disabilities, people who need long-term 
care. That is where most of the money goes. And 2 out of 3 dollars 
spent on nursing home care in the United States are Medicaid dollars.
  So we are all in this together. Those deep cuts to Medicaid are going 
to have a devastating impact, as will the other changes that are going 
to make health insurance premiums go up for so many people, especially 
for seniors. And the provisions are going to harm those with 
preexisting conditions in various ways.
  I will end with one of many stories that I have gotten, personal 
testimonies I received from constituents throughout the State of 
Maryland.
  This one is from Sarah from Arnold, MD, who says:

       Without the Affordable Care Act, my family would not have 
     affordable, reliable health insurance. When my 3-year-old was 
     2 months old, he had emergency brain surgery for a benign 
     cyst. Because of this, and even though he does not have any 
     lingering effects or medical needs as a result of this 
     surgery, we were denied coverage for him before the ACA.

  That, of course, is because before the ACA, people could be denied 
coverage because of a preexisting condition. At the age of 2 months, he 
had the cyst. He was forever marked as someone with a preexisting 
condition and therefore could not get affordable coverage.
  They wrote:

       We were denied coverage before the ACA. In 2014, my husband 
     opened up his own family law practice. Because of this 
     decision, we were on our own for health insurance.

  So they bought into the exchange.

       And we are now in our second year of excellent coverage 
     thanks to the Affordable Care Act. Having a fixed monthly 
     payment with the options and privileges equal to those who 
     work for big companies has been immensely helpful. The 
     Affordable Care Act has worked for me and my family.

  Mr. President, my point is not that the Affordable Care Act is 
perfect. There are improvements that can be

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made. We should work together to make improvements, but let's not do 
something that violates what the doctors call the Hippocratic Oath. 
Let's not do something that does more harm in our system. Let's not do 
something that will result in 22 million fewer of our fellow Americans 
having access. Let's do something good together that actually builds on 
what we have, fixes what is broken, because we can make improvements in 
the Affordable Care Act, not by doing a U-turn and going backward but 
by looking forward.
  Mr. President, I really hope that we will do that together.
  Thank you.

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