[Congressional Record Volume 163, Number 124 (Monday, July 24, 2017)]
[Senate]
[Pages S4139-S4163]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




  NATIONAL DEFENSE AUTHORIZATION ACT FOR FISCAL YEAR 2018--MOTION TO 
                           PROCEED--Continued

  The PRESIDING OFFICER. The Senator from Illinois.


                               Healthcare

  Mr. DURBIN. Mr. President, this week--perhaps as early as tomorrow--
Majority Leader McConnell, who just left the floor, will ask the Senate 
to vote on a bill we have not seen. That is right. We will be voting 
this week on a bill we haven't seen. I think it is a first. I am going 
to do a little research to see if this has ever happened before in the 
Senate, where Members of the Senate were brought together to vote on a 
bill that has not been made public or printed for us to review.
  This isn't an inconsequential bill. This is a bill about the 
healthcare system of the United States of America. There is not a 
single American living in our Nation today who will not be affected by 
our vote this week because we are in the process of deciding whether we 
will change healthcare in America, health insurance in America, and 
there is not a single one of us who doesn't have a health insurance 
plan, either private or public, or not affected by the health insurance 
industry in healthcare across the United States. In fact, healthcare 
itself represents one-sixth of the American economy.
  So we are being asked to vote on a bill this week which has not been 
printed and given to us and which will change healthcare for every 
single American and affect one-sixth of the American economy.
  We do know that some of the previous provisions that have been 
brought before us on the Republican side have an impact--a negative 
impact--and in my State of Illinois, a very personal negative impact.
  We know that their effort to repeal ObamaCare, which has been a 
political slogan that has been used for 6 or 7 years, ran into a wall 
when the American people said: Well, if you repeal it, what is left? 
What will be there? What will replace it?
  At that point, the Republican effort disassembled. They didn't have 
an alternative. They spent the last 6 years

[[Page S4140]]

under ObamaCare--the Affordable Care Act--saying ``No, repeal it'' 
without spending the time to think about what would follow, what is 
next.
  The Congressional Budget Office--this is an interesting thing--the 
Congressional Budget Office is a nonpartisan agency that we turn to 
that evaluates our work. They take a look at the bills we write, and 
they take a look at the laws that will pass, and they say: Well, this 
is the impact it will have on the deficit, on future generations, on 
entitlement programs.
  Sometimes the Congressional Budget Office is maddening. They take 
forever. I don't know what is going on over there, but what you think 
is a simple question can take weeks and sometimes longer to result in 
an analysis, and there are times when I just flat out disagree with 
their analysis.
  Let me give an example. When we debated the Affordable Care Act, we 
said that one of the things we need to do is make sure there is plenty 
of preventive medicine. For example, we make sure under the Affordable 
Care Act that every senior gets a free annual physical. Our belief is, 
if you detect a problem a person has early enough, you might be able to 
lessen its impact or actually cure it. We said that to the 
Congressional Budget Office, and they replied to us: You cannot put a 
dollar value on preventive medicine.

  Well, it is common sense; isn't it? If you find something early, it 
is more likely to be cured. It is cheaper. No, you can't put a dollar 
on it.
  So the Congressional Budget Office sometimes can frustrate us, but we 
rely on them, and I would say, for the most part, they do give us good 
advice. I don't agree completely with them, but they give us good 
advice.
  Do you know what they say about the Republican repeal plans that have 
been passed in the House of Representatives and the various versions 
that have been suggested? They believe those repeal efforts will take 
health insurance away from 22 million to 32 million Americans.
  Think about that. We passed the Affordable Care Act because so many 
people in America had no health insurance, and we wanted to make sure 
they had it--for their own peace of mind, for their own good health, to 
make sure there was fairness in our system so sick people without 
health insurance who are cared for don't have their bills passed on to 
everybody else. Well, the Congressional Budget Office took a look at 
the Republican plan, which passed the U.S. House of Representatives by 
four votes--all Republican votes--four votes, and they looked at the 
plans proposed by Senator McConnell and the Republicans, and they said: 
At the end of the day, 22 to 32 million Americans will lose their 
health insurance. They said, in my State of Illinois, 1 million out of 
12\1/2\ million will lose their health insurance.
  I cannot understand how any Senator of either political party could, 
in good conscience, come here and say: Boy, we had a great week. We 
just passed a healthcare reform bill, and 1 million people in Illinois 
will lose their health insurance. Really? That is why you ran for the 
U.S. Senate, to take health insurance coverage away from people? I 
would have thought common decency, common sense would suggest we want 
to do just the opposite. We want more and more people to fall under the 
protection of health insurance.
  We also know some of the reforms we built into the Affordable Care 
Act are going to be changed by at least the early versions of the 
Republican repeal bill. Like what? One out of three Americans has a 
preexisting medical condition. A few weeks ago, I went through a heart 
procedure that worked out just fine--thank you--but now I have a 
preexisting condition. I am in pretty big company: one out of three 
people across the United States.
  Remember the day before we passed the Affordable Care Act? Before we 
passed the Affordable Care Act, if you had a preexisting condition, if 
you could get health insurance, it was darned expensive.
  A good friend of mine had a trucking company. He had some problems 
with his ankle. He went to the doctor. The next year, when they wrote 
the health insurance plan for his trucking company, they excluded 
anything on the health insurance policy affecting his legs and his 
feet. Each year, he said, I was afraid to turn in any claim because the 
next year they wouldn't cover him. It is a preexisting condition.
  We changed that. We changed the law. We said, in America, when you 
sell health insurance, you cannot discriminate because of preexisting 
conditions. You can't discriminate with higher premiums because you 
have a child with diabetes. You can't discriminate with higher premiums 
if your wife has survived breast cancer. Now, to me, that is common 
sense, and it is humane.
  The Republican approach allows the States to waive that--back to the 
bad old days, when preexisting conditions could run your premiums 
through the roof, where you have haves and have-nots when it comes to 
health insurance, and Republicans said the other protections we put in 
the Affordable Care Act are also on the chopping block.
  For example, my wife and I raised three kids, put them through 
college. They had their health insurance when they were students. They 
came out of college looking for jobs--thank you--and it took a little 
while to find the right job, and we worried: Now that they are not in 
school, whose health insurance is going to protect them while they are 
looking for a job with benefits?
  We put in the Affordable Care Act that your kids--young adults--can 
stay under your family health insurance plan until they reach the age 
of 26. It is just common sense. Keep them under the family plan until 
they have a chance to get that job with benefits.
  We put other provisions in there--lifetime limits. It used to be, you 
would buy health insurance in this country and to keep the costs down, 
they would say: We have you covered. Up to $150,000, you are covered. 
Now, $150,000 sounds like a huge amount of money to people of modest 
means and working families, but we all know you are one accident or one 
diagnosis away from having medical bills that go through the roof. So 
$150,000? Get real. That could be 2 days in a hospital with a doctor 
and a surgery or radiation. That is the reality.
  So we took lifetime limits off the policies. They can't do that to 
you in America anymore. When you buy health insurance, you have health 
insurance, and if, God forbid, your condition takes your bills to sky 
heaven, they are going to be covered. Now the Republicans say: Well, 
that is another thing we will take out. We will make that optional.
  Can I tell you one other one that really gets me because it was a big 
debate here for years. Back where my friend Senator Sheldon Whitehouse 
is standing used to be the desk of Paul Wellstone, a liberal Senator 
from the State of Minnesota. What a good guy--terrific guy--short, 
feisty. Boy, when he got into a fight, you wanted to be on his side.

  Paul Wellstone teamed up with a man who sat right there named Pete 
Domenici. Pete Domenici was exactly the opposite politically: from New 
Mexico, conservative, Republican, disagreed with Wellstone on virtually 
everything, except for one thing. Each of them had in their families 
someone suffering from mental illness. They decided they were going to 
do something about the fact that most health insurance plans did not 
cover mental illness. It was a battle that went on for years to require 
health insurance to include mental illness and they won the battle and 
we put it in the Affordable Care Act. Now, the Republicans say: Let's 
make that optional. This is something you can buy if you want to buy 
it.
  At the end of the day, I think we all know we need a health insurance 
plan which is there when we need it, that covers things we can't even 
imagine when we buy the health insurance, and it makes sure people 
don't end up broke and bankrupt because of healthcare bills.
  That was the driving cause, the driving reason for people filing 
bankruptcy in America--medical bills. They couldn't pay them. Since we 
passed the Affordable Care Act, the number of bankruptcies filed 
because of medical bills has been cut in half. So good health insurance 
that covers you when you need it and covers a member of your family 
when you need it is essential. That is why this debate and this vote 
tomorrow are so essential.
  One thing I forgot to mention. Wellstone and Domenici didn't just

[[Page S4141]]

cover mental illness. They put another provision in there, and most of 
us paid no attention to it: substance abuse treatment. That has to be 
covered in health insurance too. Is that important? Have you heard of 
the opioid epidemic, the heroin epidemic?
  I recently asked one of the best providers in Chicago about this, and 
they said: Luckily, people who have a child who ends up being addicted 
and needs treatment, if they have private health insurance, there is 
some coverage. Now, there is a battle about how many bills will be paid 
and how much is paid, but it is covered under the health insurance 
plan. Republicans want to make that optional. They call it freedom of 
choice.
  The junior Senator from Texas, Ted Cruz, talks about policies you 
could buy that are really cheap policies. We call it junk insurance. 
You are insured in name only. If you need it, it isn't going to be 
there. That has been in the Republican plans that have come before us. 
We don't know whether that will be in the plan we have to vote on 
tomorrow. We don't know. It is a mystery.
  How many hearings have been held on the bill we will vote for 
tomorrow on proceeding to change healthcare in America? None. Not one. 
How many amendments have been offered? Of course, none. We haven't seen 
it. We don't know.
  We also know something else. The Republican plan on healthcare will 
slash the Medicaid Program. Most people--myself included--a few years 
ago, would have been stumped to describe the Medicaid Program and what 
it covered. Now, I will tell you what it covers, and think about 
cutting what I am about to describe by 25 to 35 percent.
  No. 1, half of the children born in the State of Illinois are paid 
for by Medicaid. Their mother's prenatal care, the birth of the child, 
and postnatal care of mom and the kid is covered by Medicaid--one-half.
  In addition to that, every school district in my State--probably in 
Rhode Island, probably in Oklahoma--receives Medicaid payments--school 
districts. Why? For the kids with special education needs. Medicaid 
helps pay for counselors so these kids can be mainstreamed in 
education. Medicaid in my State even pays for feeding tubes for those 
severely disabled children who are in school--but a 25- to 35-percent 
cut in the Republicans' proposals for Medicaid.
  The most expensive thing in Medicaid, the thing that costs the most 
money, I haven't mentioned. Is your mother in a nursing home? Is your 
father? Your grandfather? Sixty percent of the people in nursing homes 
rely on Medicaid to stay in that nursing home and get the basic care 
they need. So when you cut that by 25 to 35 percent, what happens to 
Mom? What happens to your grandfather? Does that mean the family now 
has a bill to pick up? Does that mean they have to leave the nursing 
home and go somewhere else? Where will that be? Yet that is one of the 
proposals.
  The disabled community, they stepped up as well. Medicaid is health 
insurance for disabled people in America. A woman in Champagne came to 
me and said: I have a 23-year-old son with autism. He is pretty good. 
He is kind of on his own. He is doing some things. Senator, if he 
didn't have Medicaid health insurance, I would have to put him in an 
institution. I don't want to do that.
  How important is Medicaid? How important is it that the Republicans 
will slash this Medicaid? It gets to the heart of healthcare for tens 
of millions of people in the United States of America.
  Why do Republicans want to cut Medicaid? It is simple. It is linear. 
It is direct. They have to cut $700 billion out of Medicaid to provide 
a tax cut for the wealthiest people in America.
  Oh, Durbin, you are making that up. This must be a press release from 
the Democratic National Committee. No, that is exactly what it is all 
about. In order to pay for the tax cuts to the highest income 
individuals, to pharmaceutical companies, and to health insurance 
companies, they cut Medicaid payments to the States. They think that is 
simple justice, a tax cut. They are always for tax cuts, but look who 
pays for that tax cut.
  So who lines up for and against the Republican approach we are going 
to get to vote on tomorrow? That is easy. There is not a single medical 
advocacy group in America today supporting the Republican position. 
That is a pretty broad statement. You had better be ready to back it 
up, Senator. I am ready. Hospitals, doctors, nurses, pediatricians, 
every medical advocacy group, and community clinics all oppose what the 
Republicans are setting out to do--and they are not alone. Remember the 
preexisting conditions? I mentioned diabetes and cancer. The American 
Diabetes Association, the American Cancer Association, the American 
Heart, Lung, you name it, all of those groups oppose what the 
Republicans are setting out to do. They realize it is a dramatic step 
backward in terms of healthcare in America.
  Every healthcare repeal bill Congressional Republicans have devised 
to date has represented a massive step backward for healthcare. None of 
the bills proposed by Senate or House Republicans would increase the 
number of Americans with health insurance coverage. It does just the 
opposite. None of them reduce costs or improve care.
  You say: Well, if you tell me you don't know what the bill is going 
to be, how are you describing it? I am giving the composite of all the 
bills that have been offered by the Republicans in the House and 
Senate. So far, we think--one in the House for sure--four different 
bills in the Senate, which I have just described, you will find this in 
all the bills. They don't get better, they get worse. None of them will 
strengthen our healthcare system or improve people's lives.
  One of my Republican colleagues really put it in a few words very 
directly and said recently: I didn't come to Washington to hurt people.
  I trust that none of us--not a single Republican or Democrat--came 
for that purpose. We want to help people, don't we? Isn't that why we 
are here? That is why we need to reject this approach. It is why we 
need to sit down together and make our healthcare system better.
  I voted for the Affordable Care Act. I believe in it. It cut the 
number of uninsured people in my State in half, and I think that is a 
worthy goal. It made many other changes which I have described here 
this evening.
  Is it perfect? By no means. I used this example before: The only 
perfect law that I know of was carried down the side of a mountain on 
clay tablets by Senator Moses. Everybody else does their best, and 
sometimes we need a little help. Our current healthcare system needs 
some help.
  Let me tell you where I think we ought to change it. No. 1, we know 
that the one market where the premiums are going through the roof is 
the individual marketplace, where small business people and others are 
facing skyrocketing premiums. What percentage of America fits into that 
group? Six percent. They are not being treated fairly under the current 
system. We have to change it. We have to make healthcare premiums 
affordable. Every Republican plan brought before us raises those 
premium costs.
  No. 2, we don't address the costs of prescription drugs in the 
Affordable Care Act. Health insurance companies tell us that is driving 
premium costs more than any single item. Blue Cross Blue Shield in 
Illinois pays more for pharmaceuticals--prescription drugs--each year 
than they pay for inpatient hospital care. There is nothing that is 
controlling these costs. We should; shouldn't we?
  Shouldn't we agree that, if you happen to live in some part of the 
country where you don't have health insurance available in the 
marketplace, at a very minimum you will have a public option? What do I 
mean by that? A plan that looks like Medicare, a plan that isn't driven 
by profit, but a plan that provides the basic services. We can do that. 
We have Medicare Advantage programs. We have other options. We want to 
make sure that is available to every American. You choose it, if you 
wish.
  Those three things right off the top I would include as part of what 
we can do on a bipartisan basis--Democrats and Republicans. Take the 
tax cut off the table. Take slashing Medicaid off the table. Take 
rewards to health insurance companies off the table. Focus on helping 
the families, businesses, and individuals in America who need this 
basic protection.
  We are going to go into this mystery vote tomorrow. We have been 
elected

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to the U.S. Senate. There aren't many people in history who have had 
this honor. What we are doing tomorrow does not bring honor to the 
Senate.
  Considering a bill that has not been written, published, and 
disclosed to the American people is just wrong. Considering a bill that 
has never had a committee hearing is unfair. Considering a bill that I 
am sure will have many flaws and weaknesses is reckless.
  That is what we face this week. How important is it? It may be the 
most important vote we cast this year as far as I am concerned. There 
is nothing more important in life than the peace of mind in knowing you 
have health insurance at that critical moment when you or somebody in 
your family desperately needs help.
  There is not going to be a minor amendment offered on the floor that 
will straighten out the situation.
  I know my colleagues are here to speak. I will close by saying this. 
If you come to watch this bill, whatever it is, brought before the 
Senate in the next few days, it will not be a moment when you think 
better of this place. It is a process called vote-arama. Here is what 
it means. You put an amendment on the floor and file it with the clerk. 
They read the amendment. Then you have 2 minutes--1 minute for and 1 
minute against--and you vote.
  Really? We are going to take the healthcare system of America and put 
it through that kind of a process, where we don't even have time to sit 
and measure the impact of one amendment over the other? The 
Congressional Budget Office will not have its analysis. So it is really 
going to be a free skate. We will be up here trying our best to vote 
yes or no on these amendments if we proceed to the bill.
  Here is the good news. If 3 Republicans--3 out of 52--will step up 
and say: Stop, we can do better as a Senate, that will be the end of 
this terrible endeavor. We will send the measure back to committee. We 
will have Democrats and Republicans sit down. They will go through the 
regular process. They will produce a bill. The public will get to read 
it. They will go through expert testimony. Then we will have an 
amendment process. Then they will bring it to the floor, and we will do 
the same. We will consider it carefully. We will use our best judgment 
and try to come up with something on a bipartisan basis that is a 
credit to America.
  Instead, what we are going to face, if the majority leader has his 
way tomorrow, is a process that does not serve this country well and 
does not bring honor to the Senate.
  I urge my Republican colleagues, three of them at least, to step up. 
They aren't just saving a lot of people across America from the worry 
of whether they have good health insurance when they desperately need 
it. They are saving the reputation of the Senate.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Daines). The Senator from Pennsylvania.
  Mr. CASEY. Mr. President, I rise tonight to speak about the 
healthcare legislation. I am grateful for the remarks of our colleague 
from Illinois, the great leader that he is, talking not only about the 
impact on his home State but on our country.
  I think a lot of us, especially in the last couple of weeks, have had 
an opportunity both to debate healthcare and, probably more 
importantly, when we go home to be on the road, to go to places where 
folks are thinking about it very intensively.
  Many people I had a chance to interact with and, really, to listen to 
on the road were folks in small towns and rural areas, especially, who 
probably didn't ever imagine they would have to engage in this kind of 
a discussion or debate. Coming into a conference room to have a 
discussion or a roundtable about healthcare is not what they do every 
day. They don't necessarily sit around to talk about a public policy 
issue. They usually have so much in their lives that keeps them busy 
and so many concerns and so many challenges that are weighing them down 
that they don't have any opportunity to have these kinds of 
conversations.
  Many of them felt obligated to have these conversations. Many of them 
were motivated to speak out because of what would happen in their lives 
and usually in the life of someone in their family.
  When I was in a number of counties the last couple of weeks, 
especially in rural areas, you would hear from a lot of moms and dads 
about their children, usually in this context: What will the Medicaid 
cuts mean for my child? In many cases, the child has a disability or 
more than one. Sometimes there is a series of complex disabilities--
plural--and the mom or the dad is there to talk about it.
  In these discussions, you hear a combination of sentiments and a 
combination of information. You hear sometimes a cataloging of what 
their daily life is like, what they do when they wake up in the morning 
and have to get that child or that young person ready for school if 
they have a disability or more than one disability. These parents 
become experts in all kinds of medical terminology and prescription 
drugs, and they become experts in assistive technology or equipment 
that allows their son or daughter to lead as full a life as possible.
  For these families, this is real life. This isn't some debate in 
Washington that we engage in here. This is about real life. That is why 
the issue of Medicaid, I think, has been so prominent.
  If we learned one thing over the last couple of months, it is that 
some people in Washington might have thought that Medicaid could be 
described as a ``them'' program. That is for someone else who is far 
away, and I don't have to worry about that. We found out that Medicaid 
is an ``us'' program. Medicaid is an American program.
  It is one of the ways we come together as a nation and say: You are 
up against something that I might not be up against. You have a 
challenge that I might not have, but I am going to do my part to 
support that program to give you a chance.
  If you are a child with a disability, we come together as a 
community, as a nation, and say we are going to help that child. We are 
going to do everything possible to make sure that child can lead a full 
life.
  For many folks who are low income--they are working, but they don't 
have a very high income and don't have employer coverage--we say in 
that instance: You are someone we should try to help with a program 
that provides healthcare--Medicaid.
  We say to seniors, if we believe, as we do, that you have given us so 
much--whether you fought our wars or worked in our factories or both, 
or taught our children, built the Nation, or built the middle class, 
and did all kinds of things for us--the least we can do is to make 
sure, if you need extra help getting into a nursing home or getting the 
benefit of long-term care, Medicaid will be there for you, without a 
doubt.
  It is only until recently that a lot of those same families have had 
to ask the question: Will that program called Medicaid--that ``us'' 
program, not a ``them'' program--be there for my child who has a 
disability? Will that program be there for me and my family, because 
our income is such that we qualify for Medicaid and we need that help? 
Will that Medicaid be there for that older citizen who has given us so 
much, given so much to their family, given so much to the Nation? Will 
that program continue to be there to give them that little bit of extra 
help they might need to get into a nursing home?
  Unfortunately for a lot of them, it is not a little bit. It is a lot, 
because they need that much help to have the benefit of long-term care.
  I have read a number of letters on the floor over the weeks and 
months, and I will continue to do that. It is remarkable, though, how 
people have put their own stories on paper or they have been 
interviewed by a local newspaper or they have been on local television, 
or even national television, talking about their lives, talking about 
their children, talking about their worries, and also giving us the 
benefit of their hopes and their dreams for their children. They are 
hopes and dreams that would be thwarted in some instances by a vote we 
could take here. They are hopes and dreams that in some cases would be 
absolutely shattered if we took the wrong step on Medicaid and the 
wrong step on healthcare.
  Obviously, I am not a supporter of the legislation before us. It 
seems like every time there is a change made, the legislation is either 
no better or a lot worse. The number of uninsured doesn't seem to 
budge.
  The latest Congressional Budget Office determination--this is dated 
July 20, last Thursday. It is a letter from the Congressional Budget 
Office, from

[[Page S4143]]

Director Keith Hall to Senator Mike Enzi, the chairman of the Senate 
Budget Committee. I am quoting from page 4. The Congressional Budget 
Office says in this letter:

       According to CBO and JCT's estimates, in 2018, 15 million 
     more people would be uninsured under this legislation than 
     under current law. The increase in the number of uninsured 
     people relative to the number under current law would reach 
     19 million in 2020 and 22 million in 2026.

  That is what the CBO tells us. Once again, we have that same number--
that stubborn number--22 million people uninsured, and 15 of the 22 
becoming uninsured in 2018, next year. It is an immediate impact, the 
likes of which and the gravity of which we can't even begin to imagine. 
Imagine that, in the course of 1 year or maybe 1\1/2\ years, 18 million 
people in the country are losing their healthcare, just when we made 
the advancement of having 20 million people covered between the time 
the Patient Protection and Affordable Care Act was passed and just in 
the last year or so.
  We have made all that progress forward on coverage. One of the 
consequences--one of many but one of the consequences of this 
legislation--would be to wipe all that out. It is two or three steps 
forward and several steps backward. That alone makes no sense.
  As I said, when people come to meetings across the State about this 
bill, it is remarkable what they will tell you about their own 
challenges. It has to be very difficult to stand in front of a group of 
relative strangers--and sometimes with media there--and express to you 
or express to the people in the room or to the people listening in an 
interview or otherwise their innermost fears. That has to be 
disturbing. It must be difficult to do, but they feel compelled to do 
it because they have never had to worry like this--never had to worry 
in the course of their lifetimes about a direct threat to the 
healthcare of their children, a direct threat to the healthcare that 
their family has.

  I have notes here from a meeting just a couple of weeks ago. I will 
not say who the parents are; I don't have their permission. But I will 
say this: It was a parent in a county that is considered rural, a 
family that seems to be relatively secure in terms of their employment 
and everything else in their lives. After describing what Medicaid 
means to their family because they have a child with a disability, the 
mom talked about her own insurance. This is a common theme. The parent 
or parents have a good job or sometimes two good jobs, and they have 
insurance in most cases. Yet, because of the severity of the disability 
of their child, they have to have Medicaid. There is no choice. There 
is no way with 20 jobs that they could pay for the services that child 
needs--services, therapies, treatments. The good news is, we live in a 
country that has those available, but a lot of that will be ripped away 
if we pass this legislation.
  Here is what this mom said when talking about what she is determined 
to do for her child. She said: It is not negotiable. That is what she 
said about what is provided to her child. She said that these are 
necessities. These aren't extra things. These aren't just add-ons to 
some other healthcare. These are absolute necessities. Then she went 
through and itemized and cataloged all the ways and all of the tools 
and benefits that her family receives from Medicaid so that her child, 
who has a severe disability, might have a shot to lead as full a life 
as possible.
  The idea that this mother or anyone like her should have to come to a 
meeting in the United States of America and have to make an argument as 
to why those services should be preserved for her son or her daughter 
or any other member of her family--the idea that she should even have 
to make that argument is insulting to us as a country. We would be a 
different country if Medicaid were changed in the way some folks around 
here want to change it.
  I have used the word ``decimation.'' That is exactly what it is. It 
would be decimation, and a lot of families' lives would be destroyed. 
This is real life for these families.
  Even if someone could prove that a year from now or 5 years from now 
or 10 years from now, that mother and her family would be somehow 
walled off or protected--even if you could guarantee that, it is still 
wrong because she shouldn't have to worry for a minute. She should have 
no uncertainty about whether her child is going to have Medicaid going 
forward--her child with a profound disability. There should be no 
question. That child should get Medicaid today, tomorrow, and as long 
as they need it for the rest of their life because we are a great 
country. We do that in America. We can do it over and over again.
  We can have the strongest economy. We can have the strongest 
military, and we can take care of those families, no matter what, no 
questions asked, whatever it takes because that is who we are as 
Americans. But there are some people around here who just don't believe 
that. To use that mom's word, they think it is all negotiable--that if 
it is the right year and the numbers line up, maybe we can help you.
  We need a tax cut, apparently. That is what they argue. They need a 
tax cut for wealthy folks, so Medicaid is going to pay for that. To say 
that is insulting is a gross understatement. That is obscene. That is 
as close to uttering an obscenity as anything I can think of. So you 
bet we are going to fight when it comes to those kinds of decisions--
fight against those kinds of cuts.
  I mentioned that I had been on the road a good bit and have spent a 
lot of time in counties that are rural counties in Pennsylvania. Just 
to give you an example of the numbers, I live in a State that has 67 
counties, and 48 of the 67 are rural. Those are our Pennsylvania 
counties. If you add up all of the individuals in those 48 rural 
counties in Pennsylvania who got insurance by way of the Medicaid 
expansion--or received insurance in the marketplaces in the intervening 
years between passage of the ACA and currently--just in those 48 
counties, over 278,000 people have healthcare--278,266. I use a precise 
number because right down to the 66, it matters. Every single one of 
those individuals in those 48 rural counties should have an ironclad 
guarantee that no bill will pass the U.S. Senate that will rip away 
their healthcare, not for one person. That should be our promise to 
them.
  That is the number of people covered, right? With the Medicaid 
expansion plus the marketplace, 278,266 residents of rural Pennsylvania 
are covered. If the Senate bill passed, here is at least one estimate 
of what would happen to those rural counties: 151,000-plus people. I 
will not use the exact number because it is an estimate. The estimate 
is that around 150,000 people would lose their health insurance. You 
move forward in rural Pennsylvania by over 278,000 people; then you 
take two steps backward and rip healthcare away from 150,000 in rural 
Pennsylvania. I haven't gotten to the big population centers. That is 
the reality in Pennsylvania.
  Then if you break it down even further--these are just 11 rural 
counties that I visited in the month of July in addition to other 
counties. In 11 rural Pennsylvania counties--these are counties with 
very small populations. One of them, Forest County, which I was in this 
weekend, has a little more than 7,000 people in its total population. 
In these 11 rural Pennsylvania counties, 54,180 people have healthcare 
today because of Medicaid expansion, plus those who got it through the 
marketplace, so 54,180 get healthcare. What is the estimate of who 
would lose if the bill passed? It is 32,410. Let's call it 30,000, 
roughly, because it is an estimate. So 54,000 gain; then you rip it 
away from 30,000. Does that make any sense at all? Does that help the 
country? How are we stronger after that? How are we better off as a 
country or, in my case, as a State? How are the people of our 
Commonwealth better off when 30,000 in 11 rural counties lose their 
coverage--or 150,000 in 48 rural counties?
  I know I am over my time, and I will wrap up because we have 
colleagues here. This is a pivotal moment. To say it is a pivotal 
moment for the Senate is a big understatement, but it is also, I think, 
a pivotal moment for the country. We are going to be on a different 
path than we have been for a long time. Usually what happens over time 
is that you are expanding protections, enlarging the number of people 
who are the beneficiaries of protections of one kind or another. In 
this case, we would be going in the wrong direction.
  I hope our colleagues will think long and hard before they vote yes 
either to move forward to debate on a bill that is

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deeply flawed or to vote for the bill itself.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Washington
  Ms. CANTWELL. Mr. President, I thank the Senator from Pennsylvania 
for being here. We have been out here many a night, talking about the 
importance of Medicaid. I so appreciate his leadership in the Senate on 
this very important issue. He has been a champion of the Children's 
Health Insurance Program and has been a voice amongst all Senators in 
making sure that people have access to healthcare. I so appreciate 
being out here with him tonight.
  I don't really appreciate being here right at this moment. I am 
really flabbergasted. Why are we here at this moment? Why are we here? 
I am pretty sure that President Trump, when he was candidate Trump, put 
in a tweet that he would not cut Medicaid. Yet that is the proposal we 
are talking about.
  No matter what the proposal is--repeal, the House bill, the proposal 
scored by CBO or some Senate alternative on junk insurance--they all 
are a cut to Medicaid, so I am not sure how we are here. I am not sure 
how we are here when the Vice President at the time campaigned, I am 
sure, against the Affordable Care Act and then became Governor of 
Indiana and implemented Medicaid expansion in his own State. After 
saying that he was against the Affordable Care Act, he implemented 
Medicaid expansion. I am sure people in his home State said: If you 
want to take care of people, if you want to raise our standard of 
living, if you want to keep down the costs of healthcare delivery and 
private insurance, put people on coverage so that they aren't driving 
up the cost of uncompensated care.
  So how are we here? How are we here when our House colleagues came up 
with a proposal that basically cuts 23 million people off of 
healthcare--including 15 million people on Medicaid--after working with 
the President, who said that he didn't want to cut Medicaid, and the 
Vice President, who basically campaigned against it and then went ahead 
and expanded it?
  I can't believe how many times I have been on the Senate floor, and I 
haven't seen one of my colleagues come down here and talk about 
solutions that they are proposing. I just hear them come and talk about 
the repeal of the Affordable Care Act and kicking millions of people 
off of the healthcare they currently have.
  Tonight, I can imagine there are many people across the United States 
of America who are like me, thinking, how could this be happening? How 
could we be sitting here tonight, not knowing what the Senate is going 
to vote on, not knowing whether they are going to repeal their health 
insurance, not knowing where their Senators stand or even if the 
Senator knows what proposal they are voting on? Yet I can tell you 
this: More than 70 percent of the American people think the ideas that 
have now been put forth by the House and the Senate Republicans and the 
President do not work. They are not the way to increase access to 
healthcare and drive down the cost of private insurance in the 
insurance market.
  You don't have to take my word for it. I am looking at a statement by 
Ohio's Republican Governor, John Kasich. I worked with John Kasich in 
the House of Representatives. He was a budget hawk. He wanted to figure 
out how to make things work. So I trust that, as Governor, he is a 
fiscal steward about how to get things done when he says: ``Until 
Congress can step back from political gamesmanship and come together 
with a workable, bipartisan plan, it is a mistake for the Senate to 
proceed with a vote on Tuesday and force a one-sided deal that the 
American people are clearly against.''
  So why are we here? Why are we here when a President promised that he 
wasn't going to cut Medicaid, a Vice President said that he was against 
the bill but then went and did Medicaid expansion? The people in the 
United States responded very clearly that they are not interested in 
cutting millions of people off of health insurance because they know 
that, even if it doesn't affect their family, it doesn't make common 
sense for keeping down the costs of healthcare.
  So I ask my colleagues to stop and think about the people in the 
United States of America who are clearly scared to death about what is 
going to happen tomorrow. They are scared that someone in their family 
or that they, the provider for their family, are not going to be able 
to provide insurance.
  If you are so brave, come down here and volunteer, as an amendment, 
to cut all of us--cut the Senate off of our access to health insurance 
until we come up with some idea that you think is so terrific. I doubt 
you will come and propose that. You wouldn't want your family cut off 
of healthcare.
  I meet people like Emily Talbot, who came to visit me from Seattle 
Children's Hospital, who at age 6 was diagnosed with a condition that 
affected her brain tissues and spinal canal. She was from Idaho, and 
she was referred to Seattle Children's because it is the pediatric 
referral center for our region. Thanks to Medicaid, she saw 11 
different pediatric subspecialists and had 13 brain surgeries and 7 
back surgeries. Her mom told me that without Medicaid and without the 
prohibition on lifetime caps, she wouldn't have access to healthcare 
today.
  Is that what my Republican colleagues want to say tomorrow, that ``we 
don't really know for sure how we are going to do this, we don't really 
know what works, but even though we said we weren't going to cut 
Medicaid, we are going to cut people off of health insurance who 
currently have coverage?''
  I think the reason why people like these Governors from Republican 
States have been willing to speak out against this proposal and raise 
their concerns is because they have to be a steward of Medicaid, and 
they have to be fiscally responsible. So they know there are better 
ways.
  When I talk to the regional hospitals in my State, they tell me that 
covering more people under Medicaid has created downward pressure on 
price in the individual market. It has helped us.
  So our solution cannot be decimating the Medicaid market. Our 
solution has to look at those in the individual market who don't have 
as much clout as a big employer or somebody who can buy in bulk and 
drive down their price. There are ways to address that issue.
  I look forward to working with my colleagues on those solutions, but 
that is not what is being recommended tomorrow. Those solutions haven't 
been put forth, nor are they part of any of these proposals. So I ask 
my colleagues to not proceed.
  The President promised he was not going to cut Medicaid, and now it 
is like you want somebody to jump off the cliff tomorrow, and you are 
saying: Oh, by the way, I will throw you a parachute on the way down. 
It doesn't work.
  As my colleagues have said here tonight, it is time to give certainty 
to this population that we have a proposal that will help continue to 
give them access to care. I would say to my colleagues that taking a 
vote on politics when it is the lives and the healthcare access that so 
many millions of Americans seek--don't play politics with healthcare. 
Let's get a solution that works and works on both sides of the aisle.
  I thank the Presiding Officer, and I yield the floor.
  The PRESIDING OFFICER. The Senator from Rhode Island.
  Mr. WHITEHOUSE. Mr. President, let me open my remarks by saying that 
from the very beginning of this ill-starred healthcare misadventure the 
Republicans have been on, Democrats have over and over again offered to 
help and to participate. Over and over again, we have spoken to, for 
instance, Chairman Alexander on the HELP Committee, saying: Give us a 
shot. Try something. We can do this. You have talked all these years 
about regular order.
  How many times have we heard the majority leader say that regular 
order is the way to go and talk about how important the Senate is 
because it follows regular order? It looks as though all of that was 
nothing but a lot of bunkum because when he had the chance to come here 
and actually trust the Senate to work through regular order, what did 
he do? The very first day, he jammed through reconciliation to open a 
purely partisan pathway to undoing ObamaCare.
  Well, people have discovered that a lot of what they thought was 
their

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good healthcare is ObamaCare. So people on Medicaid, people whose 
private policies now don't have preexisting condition limits, caps on 
how much can be spent in a year or in a lifetime, folks who will get 
their money through the exchange, suddenly they have all discovered 
``Oh my gosh, that was ObamaCare. Don't take that away from me.'' That 
is one of the reasons we see all of the groups who come here concerned 
about healthcare lined up against this bill.
  This bill, other than the creepy cabal of billionaires who are behind 
it, doesn't have a friend. And it just shows how narrow the Republican 
Party has now become that they will follow the creepy billionaires off 
the cliff against the advice of so many respected American 
organizations.
  How about the American Cancer Society? The American Cancer Society 
says that the Republican bill would leave patients and those with 
preexisting conditions paying more for less coverage. They have come 
out against the bill.
  I have a constituent home in Rhode Island, and her name is Patricia. 
She and her daughters live in a beautiful place in Rhode Island, 
Wakefield, RI. Like a lot of people I have heard from, Patricia is 
afraid. She is afraid that what this Congress is going to do is to 
repeal the Affordable Care Act and let health insurers go back to 
discriminating against people with preexisting conditions.
  What is hers? Well, Patricia and her daughters have a genetic 
mutation, and that genetic mutation increases their risk of cancer. 
They would ordinarily be counting on the American Cancer Society to 
argue for them, and sure enough, the American Cancer Society has come 
out against the Republican health legislation.
  Well, it got real for Patricia last year when her 34-year-old 
daughter was battling breast cancer. Fortunately, her health insurance 
covered her treatment, and it worked. She is now cancer-free. But 
because of their genetic mutation, Patricia and her daughters will need 
to be screened frequently for the rest of their lives. Under the 
Affordable Care Act, these potentially lifesaving screenings are 
covered, and Patricia and her daughters are not penalized for having a 
preexisting condition. Why on Earth would you want to go back to a 
world in which those two things weren't true?
  Patricia wrote:

       A genetic mutation is not caused by an unhealthy or 
     careless lifestyle, as some members of Congress seem to 
     think. You can do everything ``right'' and still end up with 
     cancer or another debilitating disease.

  So she urged me to consider all the people who would be affected by 
the new healthcare bill, not just looking out for the rich and the 
healthy.
  Another group who came out against this was the American Association 
of Retired Persons, the AARP. This bill may have changed, but the 
results are the same. The results are higher costs and less coverage 
for older Americans. Why would you want to do that? And this isn't just 
language from the AARP; it comes home again.
  Lisa from Pascoag, up in northern Rhode Island--a bucolic, rural part 
of Rhode Island--wrote to share her experience with the Affordable Care 
Act. This is her and her husband's third year on their ACA plan. Like 
many Rhode Islanders, they qualify for financial assistance to help 
them afford their health insurance. You would think that would be a 
good thing. Lisa thinks it is a good thing. She wrote to me that she 
thanks God every day that they have quality health insurance they can 
afford.
  Her husband is a welder fabricator--a job that takes a toll. He has 
had several blood tests this year and recently began seeing a 
hematologist. Lisa knows that this type of specialty care would have 
been out of reach for their family without their current coverage, and 
so she is worried. She is frightened by the Republican health plan.
  She and her husband are 56 and 62 years old. They are within AARP's 
interests. And she understands that because of their age, under the 
Republican plan, their premiums could go up five to eight times what 
they are paying today--five to eight times what they are paying today--
and the tax credits that have been proposed, in Lisa's words, ``won't 
cut it.''
  Doctors know a little bit about healthcare, and the American College 
of Physicians has come out in opposition. ``The BCRA . . . will not 
preserve and improve essential coverage, benefits and consumer 
protections, and access to care'' is their concern. Of course, why 
would you want to listen to the doctors about healthcare when you have 
a little pack of creepy billionaires who are telling you what to do? 
Never bother to listen to the doctors.
  Well, Judith from Riverside, RI, is a doctor. She is a physician who 
works at a community mental health center in Providence. Judy told me 
that she sees the benefits of the Affordable Care Act every single day. 
She treats patients with serious mental illnesses, and they have what 
she called ``tremendous'' healthcare and social service needs. Prior to 
the Affordable Care Act, almost all of her patients were uninsured, and 
she spent her days scrambling to try to find different avenues to get 
them free care, to get them whatever they could scrounge. Since the 
expansion of Medicaid under the Affordable Care Act, she said, almost 
all of her patients have health insurance and they are able to get the 
medical care they need. As Judy put it, with all of their life 
challenges, at least they don't have to worry that they can't afford 
care.
  Planned Parenthood is a favorite target of our Republican friends, 
and Planned Parenthood is strongly opposed to these measures. Women get 
a lot of their healthcare from Planned Parenthood. Planned Parenthood 
said: ``With this latest version of TrumpCare, women will pay the 
biggest price of all.''
  Olive is a young woman living in Providence who shared her experience 
with me about how Planned Parenthood has been a reliable source of 
healthcare for her throughout her life. As a college student, Olive 
went to Planned Parenthood for birth control and well-woman care. She 
had a routine exam, and a doctor at Planned Parenthood found a lump in 
her breast. Twenty years old and far from her family, Olive said she 
was worried but never felt alone. Planned Parenthood connected her with 
the followup care and testing that she needed. She was treated by their 
doctors. Fortunately, the mass turned out to be benign, but Olive says 
she is forever grateful to Planned Parenthood for their help to her 
during a scary situation for a young woman.
  Olive is still a patient at Planned Parenthood, and she even 
volunteers at their health clinic in Providence. She knows firsthand 
how important Planned Parenthood is for healthcare for millions of men 
and women across the country--particularly women--and, like the other 
people who have written to me, she is afraid of what will happen if 
Republicans succeed in defunding Planned Parenthood.
  Small business folks have spoken to me about this. There is a lot of 
talk about how you need more freedom not to have insurance and freedom 
to be told you can't have insurance if you are sick. That is not the 
kind of freedom I think we really want to support around here. The 
freedom we want to support is for somebody to be able to follow their 
dreams, and over and over again, I hear from people who are able to get 
free of being linked to their employer healthcare plan and go out on 
their own because of the Affordable Care Act.
  Laura is a small business owner in our capital city, Providence. She 
and her husband own an architectural design and construction firm that 
builds homes around Rhode Island. Construction is not a line of work 
you want to be in without health insurance. Well, because of the 
Affordable Care Act, Laura and her husband have affordable health 
insurance and dental coverage, and they have it for the first time. 
They can see the doctors they want to see, and their out-of-pocket 
costs are reasonable.
  The Affordable Care Act has allowed small business owners like Laura 
and her husband to pursue their professional dreams, boosting our local 
economy and creating jobs for others without having to risk their 
livelihoods and life savings if an illness or an injury befalls them.
  Just last night, I was in Narragansett, RI, and a woman came up to me 
to say: When you get back down there, please fight for us on the 
Affordable Care Act.

[[Page S4146]]

  She said: The Affordable Care Act has given me two things. One, it 
has given me my freedom. Because of the Affordable Care Act, I was able 
to leave my employer-supported program and have the confidence to go 
out on my own and become an illustrator.
  Her business is so successful that she has actually started hiring 
people to support her business.
  She said: That freedom to be an entrepreneur, to succeed, would never 
ever have happened if I had been chain-locked to my employer program 
and did not have an affordable option like the Affordable Care Act 
provides.
  Second, she said: Once I did this, once I started my business, I then 
went for checkups. I was able to get tests that I could not have gotten 
before, and what they found was a tumor behind my eye. Luckily, it was 
not cancerous, but had they not caught it, she said, I would have lost 
my sight.
  If you are an illustrator, being blind is a very tough proposition. 
She said: I have my freedom, and I have my sight because of this law. 
Sheldon, fight for me.
  Janice from Cranston is the last person I will mention tonight. She 
wrote in to share how important the Affordable Care Act has been to her 
and her husband and how important our Rhode Island marketplace has been 
for her.
  She said: There may be marketplaces that aren't working in different 
places around the country. Fine, go fix those. Don't mess with mine.
  It is working in Rhode Island, and Janice is one of the beneficiaries 
of it. She is now retired. She lives with her husband Bob in Cranston. 
Before the Affordable Care Act, she tried to buy health insurance in 
the individual market, and it was quoted to her at $800 per month--not 
affordable to her, not with limited income like that. So Janice and Bob 
have quality affordable insurance through Rhode Island's health 
insurance exchange, and they are happy about it. Don't disrupt their 
lives.
  Janice actually told me that her health insurance premium actually 
went down this year, and so she splurged with the savings and bought 
dental insurance as well. That was a success. She wrote to me: ``I 
wouldn't have been able to afford healthcare if it wasn't for 
ObamaCare.''
  Like so many of these other people who have written in, Janice says 
that she and Bob are scared to death that they will lose their 
insurance if the Affordable Care Act is repealed. She doesn't 
understand how some Members of Congress can claim to care about their 
constituents and still try to repeal their healthcare coverage. Janice 
said: ``They have money and they have good insurance, and they must not 
know what it is like for people like us.''
  Well, we need to remember those real people out there who are getting 
the Medicaid benefit, who are getting affordable insurance through the 
exchanges and getting help with the premiums and the people who are on 
private insurance but no longer have to face lifetime caps or annual 
caps or preexisting conditions. Even people who are still on Blue Cross 
have gotten a benefit from this. Why would we want to take that all 
away?
  The last thing I want to mention is this. Those are all personal 
stories, and it is really important to remember that behind this creepy 
billionaire effort to perform some kind of ideological experiment on 
people by taking away their healthcare, there are actually real people 
who are really going to suffer in their real lives, and it will have 
been deliberately done to them by people here who simply couldn't say 
no to the creepy billionaires.
  There is another piece of this. It is a little more complicated, but 
I will close on this.
  I love to use this graph. I use it all the time. This axis of the 
graph shows how long people live in different countries. The range is 
from 72 to 86. This part of the graph shows how much people pay in 
different countries for healthcare per year. Virtually everybody that 
we compete with is right in here--Japan, Greece, United Kingdom, 
Germany, and France. They are right in here. They do pretty well on 
life expectancy, and here they are in this cross of the $2,000 to 
$6,000 per year range. The most expensive other country in the world is 
Switzerland, at $6,000 per year. Look at where the United States is. We 
spend $8,500 per year--way more, double more than what the average is 
of the other countries we compete against. For that we get super killer 
life expectancy. I guess killer life expectancy isn't the right phrase 
to use. But do you get great life expectancy on that vast expenditure 
of healthcare? No. We compete with the Czech Republic. We compete with 
Croatia. Part of what the Affordable Care Act did was to try to focus 
on this.
  Here is the punch line. One of the things we do in the Budget 
Committee is that we look at things in 10-year chunks. If you look at 
the 10-year chunk from 2018, which is this year right here, to 2027, 
here is a 10-year period. What this graph shows is that, back here in 
2010, the Congressional Budget Office did a prediction of what the 
healthcare costs for the country was going to be in this 10-year 
period. They said this is how much we are going to have to spend on 
Federal healthcare.
  What happened is that we passed the Affordable Care Act and costs 
started to go down. They came in below expectations. Around here, they 
rebooted the test, and they did a new projection based on the new 
information for this same 10-year period. As you will notice, the costs 
that we have projected for that 10-year period from 2018 to 2027, 
inclusive, have fallen. They have fallen by $3.3 trillion.
  If you want to talk about savings on our debt and deficit, if you 
want to talk about savings in healthcare, this red line was projected 
before the Affordable Care Act, and the green line--the difference--was 
the projection after the Affordable Care Act was law and after the 
results began to come in.
  I can't promise you that every single one of those $3.3 trillion in 
savings was a direct result of a provision in the Affordable Care Act, 
but when we have delivered $3.3 trillion in savings, why would we never 
want to talk about that? Why would we want to put any of that at risk? 
Why would we want to go back to the preexisting condition of this 
prediction and pile $3.3 trillion back into that out-year period? It 
makes no sense.
  So whether you are a person who has constituents who are real and who 
are going to suffer, who are going to suffer in real life as a result 
of the decision and the vote that you cast tomorrow, or whether you are 
a propeller-headed budget hawk who just wants to figure out how you can 
reduce America's costs, why would you vote for a bill and put any of 
this at risk? Why the fear of your constituents? Why the $3.3 trillion 
in savings? It makes no sense.
  I will end where I began. If people will come to their senses and 
want to do this in a bipartisan fashion, during regular order--boy, did 
we hear a lot about regular order until regular order wasn't wanted any 
longer--we are here. We want to work with you. There are tons of ideas 
out there. We can work to improve the healthcare system for the real 
people in the real world, and not just do what we are told by a cabal 
of creepy billionaires who are yanking the chain of the Republican 
Party.
  With that, I yield the floor.
  The PRESIDING OFFICER. The Senator from Massachusetts.
  Ms. WARREN. Mr. President, a few weeks ago the Senate Republicans had 
to cancel a vote on the healthcare bill because the number crunchers 
over at the Congressional Budget Office, or the CBO, pointed out that 
the Republican bill was going to take away health insurance from 22 
million people and drive up the costs for millions more. So Senate 
Republicans started throwing new plans together, one after another, 
rolling the dice and hoping the CBO would come back with a better 
number.
  Here is a quick guide to what the Republicans have tried since the 
last time they canceled their vote on this bill. First, there was a 
bill that was, basically, the same as the first version but that 
included a little bit more money. CBO said it still knocked 22 million 
people off their healthcare coverage.
  Second, there was a bill to simply repeal the Affordable Care Act, 
with no replacement whatsoever. CBO said that one would knock 32 
million people off their healthcare.
  Third, there was a proposal by Senator Cruz that would let insurance 
companies offer insurance at one price to people with no preexisting 
conditions and another price for anybody who had anything wrong. We 
don't

[[Page S4147]]

even have a CBO score for that one because CBO had trouble figuring out 
how many people with preexisting conditions who really needed insurance 
would never be able to pay for it under that bill.
  Why is it that the Republicans have so much trouble coming up with 
something--with anything--that would improve healthcare in America? The 
problem is that the Republicans' real motivation behind all these 
healthcare bills is not to improve healthcare. It is to give giant tax 
cuts to the richest families and corporations in this country. When the 
goal is a big tax cut, it is hard to come up with something that 
actually also improves people's healthcare.
  The Republican healthcare bills have gone from bad to worse to 
embarrassing. What makes this so painful, however, is that the health--
even the survival--of real people hangs in the balance.
  A couple of weeks ago, I met with families who said they hoped--they 
said they prayed--the Senate would not pass this terrible health bill. 
Each of these families had a small child who had been born with complex 
medical needs.
  I met Baxter, who is only 3 years old and has cerebral palsy. I met 
Tom, who was born 4 months prematurely and needed multiple surgeries to 
help correct his medical conditions. I met Brody, who was born with his 
organs growing outside his body in a protective sac. He spent more than 
7 months at Boston Children's Hospital, undergoing complicated 
surgeries to fit his organs back inside his body.
  I met these children, and I have to state that all of these kids are 
fighters. Every one of them has endured great pain and shown courage 
and determination. Every one of them has needed help from Medicaid for 
hospital bills, breathing equipment, special feeding tubes, physical 
therapists, speech therapists, and nurses to help train the family on 
how to clean a blocked IV line or how to deal with seizures. Medicaid 
means these children get the medical care they need, and it means they 
can live at home instead of in an institution. It means their families 
don't have to go bankrupt. It is that simple.
  Without this help, these families would be destroyed. These children 
and their families are the face of Medicaid, and we fight every day to 
protect them.
  Just to be clear, Baxter's mother said to me that, without the help 
that Medicaid provided, Baxter would have died. They are good, 
hardworking parents with jobs and insurance, but they didn't have the 
millions of dollars it took to keep Baxter alive or the money to buy 
the equipment and support they needed to keep Baxter at home. Yes, this 
is about life and death, and if anyone doubts it, call Baxter's mom and 
ask her to explain it to you.
  The Republican plan isn't just cruel. It is immoral, and it is not 
who we are as a people. We are better than that.
  We shouldn't even be holding this vote tomorrow. The American people 
have begged Republicans to stop. Governors from red States and blue 
States alike have told them that this bill will be deeply harmful. 
Patient groups, the American Medical Association, pediatricians, 
nurses, hospital groups, nursing homes, and the AARP have all sounded 
the alarm, saying these bills would do irreparable damage to our health 
system and to families that are trying to take care of their loved 
ones.
  I urge Republicans to stop the politics. People across this country--
Democrats, Republicans, and Independents--don't want you to repeal 
healthcare for millions of people. Listen to those people. Listen to 
Baxter and Tom and Brody. Listen to all the people who love them.
  I know there is a lot we could do to make healthcare more affordable 
in this country. I know there is a lot we could do to make our delivery 
system work better. We could work together and build something better 
for all of America. But we can't even start down that path if we rip 
away healthcare from millions of Americans. We just cannot do this. It 
is wrong.

  Thank you, Mr. President.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Minnesota.
  Ms. KLOBUCHAR. Mr. President, I thank my colleague from Massachusetts 
for her good words and her advocacy.
  I rise to join her and my colleagues on the floor in sharing the 
concerns I continue to hear every single day in my State, whether it is 
just simply walking the parades, as I did in Stillwater, MN, where 
people would come up off the sides, or, on the Fourth of July, when a 
family with a child with Down syndrome just came off the side of the 
parade and grabbed me and said we need healthcare for our son, that we 
cannot cut him off, that we cannot make these drastic, draconian 
reductions to Medicaid--because he is the face for Medicaid.
  Right now, as far as I know, we have many versions of this healthcare 
bill. I think I heard this version referred to as option C. I was 
thinking that is not really correct because we have had options A and 
B. Those were the two House healthcare bills. We had options C and D, 
which were the two Senate healthcare bills. Then we went to option E, 
which was back to the idea of repealing without having a replacement. 
Now, as far as I know, after doing A, B, C, D, and E, we are at plan F. 
My mom was a teacher her entire life, and I learned from her that you 
cannot get much lower than F, right? I think it is time to set a new 
course, and that is to work together for a better grade for the 
American people and for a better healthcare plan, which means working 
across the aisle to make changes to the Affordable Care Act.
  The Minnesotans whom I have heard from do not like A, B, C, D, E, or 
F. On Friday, in fact, I received a letter that was signed by 121 
different Minnesota healthcare organizations, and it talked about these 
past proposals.
  They wrote this:

       Minor changes or amendments will not change the ultimate 
     impact of these bills and their deep and devastating impact 
     on Minnesota and its citizens.

  What were these groups?
  They were pretty mainstream groups, those being the AARP Minnesota, 
our children's hospitals, the Autism Society of Minnesota, our nursing 
homes, the Minnesota Hospital Association, the Minnesota Nurses 
Association, Mental Health Minnesota, our Catholic Health Association, 
our addiction treatment professionals, and many more.
  As different as these groups may be in their missions and in the work 
they do and who belongs to them and where they live, what they have in 
common is that they are dedicated to taking care of the health and 
well-being of Minnesotans. They are scared about what would happen if 
any of these proposals--A, B, C, D, E, or F--were to pass.
  They have seen that the nonpartisan Congressional Budget Office 
estimates that with a number of these bills, it would mean that over 20 
million people, if not all of them, would lose their health insurance, 
that Medicaid would get cut by more than $700 billion, and that out-of-
pocket costs would skyrocket. Deductibles for a benchmark plan could 
reach $13,000 by 2026. They have seen that the Congressional Budget 
Office has found that a repeal bill without a replacement would be even 
worse, as 32 million people would lose their coverage, and premiums 
would double.
  I understand why these Minnesota healthcare organizations are scared 
about these bills, but the people who are even more scared are the 
citizens of my State who depend on the Affordable Care Act for their 
healthcare.
  As I said, we all knew, on the day it passed, that the Affordable 
Care Act was a beginning and not an end. You cannot pass a major piece 
of legislation like that without making changes over time. 
Unfortunately, with the exception of a few minor things, we have been, 
basically, blocked from making changes because we are always having 
thrown at us this idea of simply repealing everything and causing 
chaos. After the sentiment of the American people has been made quite 
clear--and you do not have to look at a poll to know that; all you have 
to do is walk down the Main Street during any parade in our State--now 
is the time for us to work across the aisle and make some positive 
changes.
  What are those changes? For one, we know we must bring some certainty 
to the exchanges and stabilize the market.

[[Page S4148]]

  I see the Senator from New Hampshire here who is the former Governor 
of New Hampshire. She knows, along with her colleague Senator Shaheen, 
we need to have more certainty in the marketplace. That is why we 
support the bill that would do that. We should vote on that bill.
  I also support Senators Kaine and Carper's legislation--the 
Individual Health Insurance Marketplace Improvement Act--to reestablish 
a Federal reinsurance program. This bill would lower premiums by 
providing support for high-cost patients.
  Now, the Republican legislature in my State--both houses are 
Republican--joined with the Democratic Governor in our State and passed 
a similar State-based reinsurance program.

  I know Alaska, which, by all accounts, is a red State, has passed a 
reinsurance program that recently got approval from this 
administration. Just last week, as Senator Hassan knows, New Hampshire 
announced its plans to pursue one as well.
  So we can and we should come together to pursue this as one change we 
can make positively for the Nation.
  Another is, it is long past time to do something about the rising 
cost of prescription drugs. I have a bill--and I see my colleague from 
Minnesota here as well, Senator Franken. We have worked on this issue 
together on both bills, which is similar to this issue of harnessing 
the negotiating power of 41 million seniors who are on Medicare in 
order to bring drug prices down. Right now, Medicare is literally 
banned from negotiating on behalf of 41 million seniors. The last time 
I checked, the senior citizens in my State had a lot of power, and 41 
million people, especially seniors, is a lot of negotiating power. 
Let's harness that because it will not just help to bring drug prices 
down in the Medicare Program, but it will help down the line for all 
citizens.
  There is the bringing in of more competition. One way you do that is 
by dangling the prospect of competition from other countries. You can 
do it with a trigger that is based on the number of competitors you 
have in a certain market. You can do it based on an increase in price 
or you can just do it.
  I and Senator McCain, who is certainly in our thoughts and prayers 
this week, have long had a bill to allow Americans to bring in safe, 
less expensive drugs from Canada. That is very similar to that of the 
U.S. market. As I have often noted when I talk about this bill, we can 
see Canada from our porch in Minnesota. We can see those lower prices 
right across the border.
  When we have developed so many lifesaving drugs, when we have done 
the research, when we have put government money--taxpayer money--into 
the research, why in this country do we have the most expensive drugs 
in the world?
  I can tell you why. It is that we have not done anything about it 
here because, for too long, the pharmaceutical companies have been able 
to have their way when it comes to legislation. This is the end of 
that. Finally, the American people are starting to see this as not just 
campaign rhetoric but as a real problem when 4 out of the top 10 best 
selling drugs have gone up over 100 percent in just the last 10 years.
  Here are some more ideas.
  Senator Lee and I have a bill--bipartisan, across the aisle--that 
would again allow the temporary importation of safe drugs that have 
been on the market in another country for at least 10 years when there 
is not healthy competition for that drug in this country.
  Generics. I and Senator Grassley, a Republican from Iowa, have a bill 
to stop something called pay for delay, which is when big 
pharmaceutical companies actually pay off generic companies to keep 
less expensive products off the market. That is an outrage. I would 
challenge any Senator to vote against that. I do not think one will. 
That is why we need a vote, and that is a perfect example of a 
bipartisan bill that could be included in a package of measures that 
could be improvements on the Affordable Care Act.
  How about this one? It is the CREATES Act, which is another 
bipartisan bill with me, Senator Grassley, Senator Leahy, Senator 
Feinstein, Senator Lee, and many others that would put a stop to 
tactics in which pharmaceutical companies refuse to provide samples 
that the generic companies need to develop new drugs. According to the 
Congressional Budget Office, this legislation would save taxpayers $3.5 
billion, and the one I just mentioned on pay for delay would save 
taxpayers $2.9 billion.
  Why would we say to the taxpayers of this country that we will not do 
that, that we will not even allow it to come up for a vote?
  These are votes the Senate should and must take. Bringing up a bill 
that devastates the Medicaid Program or that repeals big parts of the 
Affordable Care Act, without having a replacement, does the opposite. 
It does nothing. These bills--A, B, C, D, E, or F--do nothing in terms 
of bringing down pharmaceutical prices.
  What is this really about? It is about the identical twins whom I met 
yesterday from Cambridge, MN, which is a small town--a town similar, I 
am sure, to the towns the Presiding Officer would find in his State or 
to the towns in New Hampshire or to the towns Senator Whitehouse would 
see in Rhode Island.
  This is about identical twins. One of the twins is a pitcher, and one 
of the twins is a catcher on their softball team. One of the twins 
found out, just in the last year, that she has juvenile diabetes. It is 
a very dangerous, dangerous thing to have at that young age. The other 
twin is perfectly healthy. Of course, the family had to go immediately 
to the doctor. They bought insulin, and the insulin had gone up three 
times what it should have in just the last few years. It is very 
difficult for them to afford now. They got the strips. They had to do 
all of this, and the price kept escalating. To add to everything else, 
now this mom is worried that one of her daughters, not two, will have a 
preexisting condition and be kicked off of the insurance.
  Think about that. They are identical twins. It could be either one. 
You do not know which one. Is it the catcher? Is it the pitcher? It is 
a lottery. If you do not have healthcare like the Affordable Care Act 
in place, it is like a lottery. You do not know which one of them is 
going to be kicked off the insurance, not have insurance, and get very 
sick and possibly die. That is what we are talking about here.
  That is not what this country is about. It could happen to anyone--to 
anyone in this Chamber, to anyone up in the Gallery, to anyone at home. 
You do not know when it is going to happen to you or your sister or 
your brother or your neighbor or your dad or your mom or your grandma 
or your grandpa. That is why we have affordable healthcare insurance.
  This debate is also about our seniors and our rural communities. As 
Senator Franken knows, we have heard time and time again from our rural 
hospitals--from Aurora to Gilbert, to Tower. I was up there recently, 
and that is what I heard about--the rural hospitals and how difficult 
it is going to be for them if any of these bills pass.
  I know it is something our Republican colleagues, all of whom are 
from rural States--Senators Collins, Capito, and Murkowski--have 
expressed real concerns about with regard to the impact of some of the 
proposed Medicaid cuts and what they would do in their States.
  Opioids. Both the Senator from New Hampshire who is here with me 
today, Senator Hassan, and certainly Senator Whitehouse have been 
leaders in this area. That is why we passed the Cures Act. That is why 
we put a bunch of funding from the Cures Act into opioid addiction 
treatment. That is why we passed the Comprehensive Addiction and 
Recovery Act on a bipartisan basis--one of the few bills that made it 
through last year.
  You cannot just run TV ads on it, and you cannot just put it on 
campaign brochures and then go out 6 months later and cut Medicaid, 
which provides the treatment for 32 percent of opioid medication-
assisted treatments we have in our State. You cannot do that. You 
cannot give beautiful speeches and go to press conferences and then 
make those kinds of cuts. I know my colleagues on both sides of the 
aisle understand this.
  This is a time when we can chart a different path forward, when we 
can end up where we should have begun but still standing, and that is 
by working together to find some positive changes to the Affordable 
Care Act for the

[[Page S4149]]

American people. Again, I said it on the day it passed--it is a 
beginning and not an end. Let's seize this moment, open the door, and 
work together for the American people.
  Thank you, Mr. President.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Minnesota.
  Mr. FRANKEN. Mr. President, I rise to talk about the effort by 
Republicans in the majority to rip apart our healthcare system and 
jeopardize the protections for people with preexisting conditions and 
to throw millions of people off their health insurance.
  Now, it is deeply troubling at this point that with less than 24 
hours until the expected vote, we don't even know which version of 
repeal the Republicans hope to pass. Do Republicans support the Better 
Care Reconciliation Act--the bill that according to the Congressional 
Budget Office, would cause 22 million more Americans to become 
uninsured, which would drive up healthcare costs and dismantle the 
Medicaid Program? Do they support the Cruz amendment, which would bring 
back junk insurance plans that offer virtually no protection and drive 
up out-of-pocket costs for vital services or will they rally behind 
their backup option, a plan to repeal the Affordable Care Act and 
replace it with nothing--that is, nothing--an approach that would add 
32 million more Americans to the ranks of the uninsured and cause 
average premiums in the nongroup market to double or will it be 
something else entirely? We don't know.
  This is reckless. This is irresponsible. The American people deserve 
better.
  Let's be clear. A vote for the motion to proceed is a vote to move 
forward with conceivably any one of these bills, and all of these bills 
are terrible. They jeopardize lifesaving care and treatment for 
millions of American families, especially those with preexisting 
conditions. They tear apart our safety net and give tax breaks to 
powerful corporations.
  Let me remind my Republican colleagues that a vote in support of the 
motion to proceed will have real-world consequences for your 
constituents who may lose their health insurance. Perhaps these are 
people you have met; people, many of whom may be losing sleep out of 
justified fear that their children or their parents, their loved ones 
or they themselves are at risk of losing their healthcare.
  I have talked to so many people in my State about these dangerous 
proposals. There is Kristi. Kristi is a young farmer in Greater 
Minnesota whose husband and two kids relied on Medicaid to access care 
when their farm was struggling.
  There is Sandy, whose mom is in a nursing home and who doesn't know 
how she will pay for the round-the-clock care her mother needs if 
Medicaid, which covers more than 6 in 10 nursing home residents 
nationwide, scales back coverage.
  Then, this is Sheri, who said that if it weren't for Medicaid, her 
son Brandon, who has cerebral palsy and hydrocephalus, probably 
wouldn't be here. I met Brandon. I think he is 18 or 19. He was born 15 
weeks early, in Minneapolis, about a pound and a half. They took him to 
the Mayo Clinic in Rochester. The Mayo Clinic said: We can't handle 
him, so they sent him back to Minneapolis to Gillette Children's 
Hospital, which could. They told Brandon's parents: He is going to 
require $1 million in care the first day to save his life.
  Brandon has had, I think, 37, 38 surgeries. He spoke at a meeting we 
had on Medicaid a couple of weeks ago in Minnesota, and he stood--he 
had a walker. He had just gotten an A-minus in his first college 
course. He was actually, in a way, the last person in the room I was 
worried about because his resilience--this guy, this kid is going to be 
amazing. I don't think he would be here if we didn't have the kind of 
Medicaid we have and the kind of Medicaid my colleagues on the other 
side of the aisle are talking about limiting in a way that will affect 
so many people I have met across my State.
  This is one of those votes that will go down in history. It is one of 
those votes that all of us will be answering for wherever we go for the 
rest of our lives.
  The former Republican Senator from Minnesota, David Durenberger, 
outlined some of the reasons Senators should not vote for this 
consequential legislation in an excellent op-ed, a piece he wrote, and 
it was in USA TODAY today. Senator Durenberger--again, a Republican 
from Minnesota and someone whom I talk to a lot about healthcare--wrote 
this piece, saying resist the bullying, don't vote for a mystery 
healthcare bill.
  I ask unanimous consent to have printed in the Record Senator 
Durenberger's op-ed.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

   Former GOP Senator: Resist the Bullying. Don't Vote For a Mystery 
                            Health Care Bill

     There will be no do-overs on this. Take it from me: a no vote 
         this week is the only one that will be defensible in the 
         years to come.
       What do you do when you are a U.S. senator and the 
     president wants you to vote for a health care bill that could 
     radically change health care?
       You ask questions. You hold hearings. You understand what 
     it would mean to your constituents. You listen to those who 
     know the system. And when it doesn't add up, you vote against 
     it.
       The year was 1979, and I was a freshman Republican senator 
     from Minnesota. Inflation was driving the already high costs 
     of health care through the roof. President Carter wanted to 
     use Medicare and Medicaid to limit increases in hospital 
     budgets in the face of rapidly inflating costs.
       Ultimately, I decided to vote against it as it would end up 
     hurting the people of my state and was inconsistent with my 
     beliefs. And then, after the vote, we--Democrats and 
     Republicans--launched an effort to learn how best to change 
     the cost curve of the entire health system by focusing on how 
     we pay for Medicare.
       This week, the Senate once again is set to vote on a health 
     care bill that will radically change how people get coverage 
     and who can afford their care. But unlike normal times, 
     Senators, you are being asked to approve a Motion to Proceed 
     to a vote:
       Without knowing what will be in the bill.
       Without knowing what the non-partisan Congressional Budget 
     Office will say about the impact of major amendments and the 
     final bill on coverage and premiums.
       With full knowledge that the Senate parliamentarian, who 
     rules on what can and can't be allowed in a budget bill, has 
     said that the Senate must remove provisions intended to 
     prevent an insurance market death spiral
       Without knowing the details of the secret state Medicaid 
     waivers the Trump administration insists will make the bill 
     work.
       Without knowing how your own state budget will be impacted.
       Without knowing how you will defend the provisions you will 
     only learn about later, including the payoffs and other 
     things that will be sneaked into the bill at the last minute.
       Without even knowing which bill you are being asked to vote 
     on, what the defining amendments will be and how much time 
     you will have when being pressed for a final vote you'll be 
     stuck with. Forever.
       A vote in these circumstances will rightly provoke anger 
     and distrust unlikely to abate. Take it from me: A no vote on 
     the Motion to Proceed this week is the only one that will be 
     defensible in the years to come.
       I have had my arm twisted by the best of them--presidents 
     and Senate leaders and party whips alike. I know how 
     uncomfortable it can be. Usually, they were able to attempt a 
     convincing argument about what is good about the bill for the 
     country or my state. But I never would have voted for 
     something so far reaching without knowing the answer to all 
     the questions above.
       Never in all my years did I experience the level of 
     bullying we see today. It doesn't look good in Minnesota, and 
     I suspect it doesn't look any better in your state.
       I know that some of you ran for office vowing to repeal the 
     Affordable Care Act, hoping to improve coverage and decrease 
     costs. As public opinion polls tell us, voters do not believe 
     this bill does the job. The good news is we haven't run out 
     of time to ask questions and to work together to fix what 
     needs fixing if we take the time to return to regular order 
     and hold hearings.
       Seven years ago, Democrats supported a bill far from 
     Democratic orthodoxy. It did not provide for single payer, 
     nor Medicare for all. Not even a public option. They handed 
     Republicans a chance to build a health system that plays to 
     our unique strengths as a nation, not to our weaknesses.
       As someone whose efforts earned the support of both 
     Presidents Ronald Reagan and George H.W. Bush to reduce 
     health care costs without leaving anyone behind, I know our 
     party can do much better. But it should be obvious to all of 
     you listening to your constituents that voting on this 
     hodgepodge of mysterious bills is not the way.
       Because there are no do-overs. The vote for the Motion To 
     Proceed is likely a vote for final passage, and the House 
     clearly stands ready to pass the Senate bill unchanged.
       There is no making good on all of the issues later. Once 
     the funds for health coverage are gone, it will take new tax 
     increases to replace them. And what's the likelihood that 
     will happen?
       There will be no hiding this vote. Let me assure you, as 
     the official scorekeeper, the

[[Page S4150]]

     CBO will eventually score the entire bill, and that's what 
     your vote will be evaluated on.
       For those who worry about re-election politics, I can 
     assure you that going into a campaign confident that you've 
     done what's best for every one of your constituents, not just 
     for those who want to stick you with a stale slogan, is the 
     best medicine you'll ever have prescribed for you.

  Mr. FRANKEN. Mr. President, there aren't many votes like this in a 
Senator's career so let's just lay this out. If you support the vote 
tomorrow, the following are some of the specific consequences that 
could follow and in many cases would follow.
  First, it is a vote that would open debate on bills that would 
undermine protections for people with preexisting conditions. This 
could happen in one of two ways. This vote could open debate on the 
potential Cruz amendment, which would allow insurance companies, as 
long as they offer ACA-compliant plans on the exchanges, to also sell 
bare-bones, skimpy plans outside of the exchanges, with almost no 
consumer protections. Under this amendment, insurers would be allowed 
to deny coverage and charge higher rates to women, older adults, and 
individuals with preexisting conditions. To my Republican colleagues, I 
ask: Do you know someone who is pregnant? Do you know someone who has 
diabetes? Asthma? Depression? Cancer? Multiple sclerosis? Substance use 
disorders? Arthritis? Dementia? Sleep apnea? Parkinson's? All of these 
people could be denied coverage under the Cruz amendment, just as they 
were prior to the ACA.
  The Cruz amendment will also bring back annual and lifetime limits, 
coverage exclusions, and more.
  When I was campaigning in 2008, and I would go around Minnesota--
cafes, VFW halls, bars--there would be a flyer up for a family who had 
gone bankrupt for someone who had gotten sick. This would bring back 
those annual limits, those lifetime limits. Do we really want to go 
back to that?
  The Cruz amendment is intended to deceive. The amendment is designed 
to make people think it would lower premiums since it would allow 
insurers to offer stripped-down plans that don't comply with the ACA's 
consumer protections, but what it actually does is skyrocket the price 
of insurance for people with preexisting conditions like epilepsy, 
Crohn's disease, and stroke, while eviscerating the quality of 
insurance for those who don't yet need, or know they need, such 
coverage.
  In fact, America's Health Insurance Plans, which is the national 
political advocacy and trade association of companies that sell health 
insurance to Americans, and the BlueCross BlueShield Association have 
said this proposal is ``simply unworkable in any form and would 
undermine protections for those with preexisting medical conditions, 
increase premiums and lead to widespread terminations of coverage for 
people currently enrolled in the individual market.''
  The fact is, these high-deductible, bare-bones plans are a dangerous 
rip-off, and many people will not even realize what garbage insurance 
they have until it is too late.
  Here is the thing. Even if the Cruz amendment were removed from the 
bill, the Better Care Reconciliation Act would still undermine 
protections for people with preexisting conditions. That is because the 
bill would allow, and even incentivize, States to waive ACA protections 
like the guarantee of coverage for basic essential health benefits.
  If you are allowed to offer plans that don't cover basic services 
like mental health, prescription drugs, and maternity care, then you 
have a backdoor channel to charge people who need those services more 
than those who don't. Not only that, States that seek waivers and end 
the guarantee of essential health benefits bring us right back into the 
world of annual and lifetime limits--a world where your care would end 
not because your doctor said so but because the insurance company would 
stop paying for it. This could be true even for people who get their 
health insurance through their employer. In fact, even if you work in a 
State that hasn't taken this waiver, your employer could have gotten 
their health insurance from a State that had.
  In short, with or without the Cruz amendment, the Better Care 
Reconciliation Act breaks President Trump's promise to protect people 
with preexisting conditions.
  Second, yes, tomorrow is a vote to end Medicaid as we know it. 
Medicaid is a lifeline, providing health insurance and access to care 
for more than 70 million Americans. That is about one in every five 
Americans. It includes seniors, pregnant women, people with 
disabilities, families with children.
  Senator Klobuchar was right about this being a lottery. Any of us can 
be in an accident. Any of us can be diagnosed at any time. Any of us 
can have a child who is diagnosed at any time with something 
unexpected.
  Healthcare really should be a right. I don't understand people who 
say: I am healthy. My kids are healthy. Why should I suffer? I am the 
victim here. Nothing has happened to me. Why should we have a system 
where I am paying for people with preexisting conditions?
  Really? Is that the attitude my Republican colleagues are taking? 
Because that seems to be the logic.
  Medicaid had been a bedrock of our healthcare system since 1965. It 
was and is a Federal promise made to States and to all Americans over 
50 years ago. And most of all, Medicaid works. But the Better Care 
Reconciliation Act would gut it. It would end the program's coverage 
guarantee, leaving States to either roll back coverage or slash other 
vital programs in order to meet their citizens' needs.
  Finally, a vote to support the motion to proceed to this bill is a 
vote to drive up people's total healthcare costs. The Republicans' 
plans decrease or eliminate the ACA's tax credits, which help people 
afford their insurance--that was part of the construct--and it 
dramatically hikes premiums for older Americans, although ones younger 
than I--I am now 66, but from 50 to 64. It drives up deductibles and 
other out-of-pocket costs that many people have to pay in order to 
receive care.
  Americans don't like these proposals. In fact, new polling shows that 
only 17 percent of Americans think they and their families will be 
better off under the Republican plans. That is 17 percent.
  What Americans want is for Republicans and Democrats to work together 
to build on and improve the Affordable Care Act. So why do my 
Republican colleagues continue to push forward on these terrible bills? 
It doesn't have to be this way. There is another option. This body can 
reject the wrongheaded and ill-thought-out proposals and allow for an 
open, bipartisan process under regular order where we can work together 
and do the things the American people actually sent us here to do--
expand coverage, lower costs, and improve care. We should have 
bipartisan hearings where we hear from nonpartisan expert witnesses 
about the challenges facing the Affordable Care Act so we can work 
together to fix what isn't working in the ACA.
  What we do know from the last few years is that coverage matters. 
This is important. Coverage matters. Just having coverage matters. 
Healthcare isn't really about these big, heroic emergencies. A person's 
health is about some of those events, but what it is really about is 
having coverage and getting continuous care throughout your life.
  Rigorous studies have shown that for every 300 to 800 adults who get 
coverage, 1 life is saved per year. Research summarized by Atul Gawande 
and his colleagues in a recent New England Journal of Medicine piece 
finds that health coverage expansions have improved people's access to 
care, improved their financial security, meaning fewer bankruptcies and 
medical bills sent to collections, improved chronic disease care and 
outcomes, improved self-reported health, and more. Overall, health 
insurance has been shown to help Americans live longer, healthier 
lives. Now is not the time to roll back our progress.
  I urge my Republican colleagues to think about what a vote for 
proceeding on this terrible legislation would mean for the American 
people.
  Paul Wellstone said that politics isn't about winning; it isn't about 
money; it isn't about power; it is about improving people's lives. Our 
constituents sent us here to improve their lives. So I urge my 
Republican colleagues to vote no. Let's work together to fix what needs 
to be fixed in the Affordable Care Act and do all we can to

[[Page S4151]]

make sure people have access to affordable, high-quality healthcare 
when they need it.
  Mr. President, I yield the floor to the Senator from New Hampshire.
  The PRESIDING OFFICER. The Senator from New Hampshire.
  Ms. HASSAN. Mr. President, I thank my colleague from Minnesota for 
his words and his advocacy on behalf of the people of his State and all 
across our country.
  I rise today to join my colleagues and once again speak out against 
the Senate Republican healthcare bill and the dangerous impact it would 
have on the people of my home State of New Hampshire and Americans from 
all walks of life.
  This week, Senate Republicans are pressing ahead with plans that 
would increase health insurance costs, give Americans worse health 
insurance, and strip away health coverage from millions of Americans. 
Yet, despite statements that a vote will come tomorrow or in a matter 
of days, Senate Republican leadership will not tell even their own 
Members what proposal we will vote on, let alone hold a hearing on the 
impact of the bill.
  As version after version of this bill has emerged from behind closed 
doors, somehow each time it is even worse than the last, and every 
version would be devastating for people across New Hampshire. These 
bills would lead to higher costs for worse coverage. In fact, the 
nonpartisan Congressional Budget Office has said we would see even 
higher deductibles than the ones we already see. This proposal would 
decimate the Medicaid Program and end Medicaid expansion. It would take 
coverage away from millions. The Congressional Budget Office has 
projected that between 22 and 32 million people would lose coverage, 
depending on which bill we vote on.
  We know that rising healthcare costs are squeezing hard-working 
people across America. I have made clear to my colleagues across the 
aisle that I am willing to work with anyone who is serious about 
working together to build and improve on the Affordable Care Act, to 
lower costs, but unfortunately these Senate Republican bills would do 
just the opposite.
  Over the past months, I have heard from people all across New 
Hampshire. They have shared their most personal stories, their 
frustrations, and their fears about what will happen if this bill 
becomes law.
  Last month, Senator Shaheen and I held an emergency hearing in 
Concord to hear from our constituents about how proposals put forward 
by Senate Republicans would impact them. We held this emergency hearing 
at 2 p.m. on a Friday afternoon in the summer, with just a day's 
notice. Yet hundreds of people showed up, and more than 50 people got 
up and shared their most personal stories about the importance of 
healthcare, of how they have benefited from the important protections 
provided under current law, including maternity care, prescription drug 
coverage, and coverage for substance use disorder services.
  One of those Granite Staters was a woman named Maura from Exeter, NH. 
Maura told us that the Affordable Care Act has been a ``financial life-
saver'' for her family. She explained to us how, when she signed up for 
health insurance through the Affordable Care Act, her premiums dropped 
by $750 a month because of subsidies. As Maura described it, she and 
her family were able to put the extra $750 each month toward childcare, 
food, and their mortgage.
  On another recent visit to Granite State Independent Living in 
Concord, a nonprofit that provides a range of assisted-living services 
for Granite Staters, I also heard about the importance of Medicaid from 
a Granite Stater named Terry. Terry has physical disabilities and 
requires the assistance of personal care aides, who are paid through 
Medicaid. They help her with daily tasks, such as getting up in the 
morning and getting dressed and preparing meals. Terry said that 
without the support from Medicaid, she wouldn't be able to go to work, 
to her job, or do basic tasks, such as shopping on her own. Without 
Medicaid, she would need to burden her family in order to complete 
everyday, basic activities, and she wouldn't be able to go to work. 
Terry fears that this support could be taken away under this 
legislation, and she is right. It could be. She said that given the 
cuts to Medicaid and the provisions in TrumpCare, she ``wouldn't get 
anywhere near what I need to survive.''
  Finally, I have heard from advocates and those in recovery from 
substance use disorders about how vital Medicaid expansion has been in 
helping them get the support they need in order to get well and back on 
their feet. In fact, those on the front lines of this epidemic have 
said that Medicaid expansion is the No. 1 tool we have in order to 
combat the heroin, fentanyl, and opioid crisis, which is the most 
pressing public health and safety challenge facing my State.
  A few weeks ago, I visited Goodwin Community Health in Somersworth 
and heard from a woman named Elizabeth. At one point in her life, as a 
result of substance misuse disorder, Elizabeth was homeless and she had 
lost custody of her son. Elizabeth is now in recovery, and she works at 
the SOS Recovery Community Organization in Rochester, helping others 
get the support they need.
  She said that she owes her recovery to Medicaid expansion and the 
Affordable Care Act and that holding on to Medicaid is essential 
because without it, many people who are in the throes of addiction 
would not be able to find help.
  Elizabeth said:

       I just really want to emphasize the ripple effect that 
     recovery has on the community. It's not just because I'm in 
     recovery that I can help somebody else. Everyone around me is 
     impacted. When we talk about the recovery revolution, it's 
     about how everyone in the community is affected when someone 
     gets into recovery.

  Elizabeth is right. People who can get healthcare can get healthy, 
and that has a tremendous ripple effect. It lifts us all. It makes us 
productive and strong.
  At the heart of all of these stories--Maura, Terry, and Elizabeth--
and the stories that I hear all over my State is the basic fact that 
our communities, our families, and our entire country are better off 
when we give more people a chance to participate, to get the support 
they need, to live their lives with dignity, to contribute to our 
economy, and to thrive.
  Unfortunately, if TrumpCare becomes law, the progress we have made 
will be lost, insurance costs will rise, and millions of people will 
lose the care that they need.
  I am going to continue to stand with my Democratic colleagues and 
fight against this legislation until we defeat it once and for all.
  I urge the people of New Hampshire and across our beloved United 
States of America to continue speaking out about how this legislation 
would impact their lives.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Perdue). The Senator from Vermont.
  Mr. SANDERS. Mr. President, I do not know--and I don't know if anyone 
knows--whether the Republican so-called healthcare legislation will 
pass tomorrow, whether the beginning of the debate will take place or 
whether it will not. I don't know that, but this I do know. The 
legislation being proposed--and by the way, we still don't know what 
that legislation is. In general, what we do know is that the 
legislation being proposed is the cruelest, most destructive, and 
irresponsible piece of legislation ever brought to the U.S. Senate in 
the modern history of our country.
  I know the media focuses on, do the Republicans have the votes, how 
is this Senator going to vote, how is that Senator going to vote? All 
of that is interesting to those of us inside the beltway. The far more 
important issue--which we don't discuss enough; the media doesn't cover 
enough--is what this legislation actually would do if it were 
implemented.
  Right now, unique among major countries on Earth, we do not guarantee 
healthcare to all people as a right. The result of that is that we now 
have today--before this disastrous legislation--28 million Americans 
who have no health insurance and even more who have high deductibles 
and high copayments, preventing them from getting to a doctor when they 
should.
  We have a bad situation now. It is better today than before the 
Affordable Care Act was passed, when we had over

[[Page S4152]]

50 million people without insurance, but no one suggested what we have 
today is where we should be. Yet we have 28 million people uninsured. 
The Republican solution to this problem is to throw another 22 million 
people off of the health insurance that they currently have.
  I want the American people to, for one moment, put themselves in the 
place of someone tonight who may be watching what we are talking about 
here, who has cancer, who has heart disease, who has diabetes or some 
other life-threatening illness. Millions of people are in that 
position. They are struggling for their lives right now. They are under 
treatment. They are thinking, what happens if this Republican bill is 
passed? Will I live and continue to get the treatment that I need or 
will I die?
  I think there are very few Members of the Senate who have met with 
their constituents on this issue, who have not seen people break into 
tears, asking: What is going to happen to me or my children or my 
parents?
  We did a teleconference townhall a few weeks ago in Vermont. We had 
some 16,000 people on the line, and a woman whose kid has a very, very 
serious illness called. The cost of the prescription drugs are off the 
chart. She asked: What is going to happen to my child if this bill goes 
through?
  Do you know what? I didn't have the guts to tell her what might 
happen to her child. I don't want to be on the phone telling any person 
in Vermont or in America that their child might die because of the 
legislation that might proceed tomorrow.
  This legislation would cut Medicaid by almost $800 billion over a 10-
year period, taking healthcare away from lower income and working-class 
families, including many children with special needs, kids with Down 
syndrome, kids who have serious emotional problems, kids whose lives 
now depend on Medicaid. When you cut Medicaid by $800 billion, many of 
those children will lose coverage entirely or receive significantly 
fewer benefits.
  This legislation, when we cut Medicaid by $800 billion, will have a 
severe and dramatic impact on nursing homes all over America. A lot of 
people don't know this, but if your mom has Alzheimer's and is in a 
nursing home or your dad has a terminal illness and is in a nursing 
home, guess what: Medicaid pays almost two-thirds of the costs 
associated with nursing home care in America. What happens to the 
people in nursing homes when you slash Medicaid? How many of them will 
get thrown out of the nursing homes? Where do they go? Are families in 
America, working-class families, going to be forced to make the choice 
of whether they take care of their parents or whether they send their 
kids to college? Those are the choices that working-class families may 
have to make if this horrific legislation gets passed.
  This legislation would dramatically decrease funding for the opioid 
and heroin epidemic that is sweeping this country, including my State 
of Vermont, including Kentucky, West Virginia, New Hampshire, Ohio, and 
States all over the country that are struggling with the opioid 
addiction problem.
  The program that provides the most funding to help deal with 
addiction treatment and addiction prevention happens to be Medicaid. 
What happens to our efforts to try to get a handle on this terrible, 
terrible epidemic sweeping our country when you make massive cuts to 
Medicaid?
  I found it amusing that when Donald Trump ran for President--oh, he 
was a great friend of the working class. He was going to stand up for 
the working class. Let me mention to workers all over this country who 
are in their sixties that if this legislation passes, your premiums are 
going to go up dramatically. That is one of the reasons the AARP 
strongly opposes this legislation.
  If you live in Baltimore, for example, where I was this morning, 
speaking to the NAACP--in Baltimore, if you are 60 years of age and you 
make $40,000 a year, your average health insurance premiums will go up 
from about $4,000 a year now to $8,800 per year, more than double. If 
you are a 62-year-old worker, making $40,000 a year--not a lot of 
money--how are you going to pay that?
  Remember, all that Donald Trump said about what a great friend of the 
working class he was. This legislation would defund Planned Parenthood.
  I get a kick out of hearing my Republican friends talk about choice, 
freedom. Oh, my goodness, they love choice and freedom. They want the 
American people to go to any place they want to go. It is all about 
what America is about. Two and a half million women have made a choice, 
and the choice they have made is that they want to get their healthcare 
from Planned Parenthood. That choice, that freedom would be taken away 
from them, starting tomorrow, if this legislation is passed.
  When you think about insurance, you think that insurance is about 
covering you in your time of need. Before the Affordable Care Act was 
passed, many millions of the American people could not get the health 
insurance they needed to address their particular healthcare crisis. If 
you had a heart disease, if you had breast cancer, if you had diabetes, 
the insurance companies would say: We are in the business of making 
money. Why on God's Earth would we want to insure you if you had breast 
cancer 5 years ago and it is possible it might recur? That is a losing 
proposition for us.
  That is what insurance companies want to do. They are not in the 
business of providing healthcare. They are in the business of making 
money. They denied, unbelievably--think about how crazy this is; they 
actually would deny coverage to people who had preexisting conditions.
  I have problems with the Affordable Care Act. It is far, far from 
perfect. It did end that obscenity of allowing insurance companies not 
to cover people who had preexisting conditions--something that is quite 
unbelievable.
  Guess what. If this legislation is passed, in all likelihood, many 
people in this country with preexisting conditions will not be able to 
get healthcare that they need at a price they can afford. We don't 
quite know how many of them will die. Nobody can make that prediction.
  I want to read for you a very interesting article that appeared from 
an institution called PolitiFact. PolitiFact is an entity that tries to 
keep a check on what politicians say. They look at you and you make a 
statement, and they say: Is this true or is this guy not telling the 
truth? I was on a TV program called ``Meet the Press'' a number of 
weeks ago. I said: Well, you know, if this Republican legislation is 
passed, thousands of Americans will die.

  And my Republican colleagues and the rightwing media said: Bernie 
Sanders is engaging in hyperbole. He is exaggerating. Who wants to see 
anybody die?
  I know nobody here wants to see anybody die. Of course not. No 
Republican does. No Democrat does. No Independent does. But we have to 
look at the consequences of what we do.
  So what PolitiFact did was take a look at the studies to see whether 
I was telling the truth.
  Mr. President, I ask unanimous consent that the PolitiFact article be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                [From www.politifact.com, June 27, 2017]

  Bernie Sanders' Projection of Thousands' of Deaths From Lost Health 
                       Coverage Is Well-Supported

                          (By Louis Jacobson)

       During an interview on NBC's Meet the Press, Sen. Bernie 
     Sanders, I-VT., didn't hold back in his criticism of 
     Republican efforts to roll back the Affordable Care Act: He 
     said such legislative efforts will literally be deadly.
       ``What the Republican proposal (in the House) does is throw 
     23 million Americans off of health insurance,'' Sanders told 
     host Chuck Todd. ``What a part of Harvard University--the 
     scientists there--determine is when you throw 23 million 
     people off of health insurance, people with cancer, people 
     with heart disease, people with diabetes, thousands of people 
     will die.''
       Sanders continued, ``I wish I didn't have to say it. This 
     is not me. This is study after study making this point. It is 
     common sense.''
       Even if it seems like common sense that insurance would 
     save lives, would it be on the scale of ``thousands,'' as 
     Sanders said? And would legitimate studies show that?


                          studying the studies

       When we contacted Sanders' office, spokesman Josh Miller-
     Lewis cited two sources.
       One is the ``Harvard study'' Sanders mentioned--published 
     on June 22, 2017, by the liberal Center for American 
     Progress. It was

[[Page S4153]]

     coauthored by a Harvard professor of social epidemiology; two 
     medical students who graduated from Harvard's T.H. Chan 
     School of Public Health, and two policy specialists at the 
     Center for American Progress.
       To come up with their estimates, the authors of the 
     Harvard-Center for American Progress report adapted the 
     results of a peer-reviewed 2014 study of the Massachusetts 
     state health care law--a law that was a model for the 
     Affordable Care Act. The 2014 study was lead-authored by 
     Harvard professor Benjamin D. Sommers.
       The Harvard-Center for American Progress study projected 
     that there would be one excess death for every 830 people who 
     lose coverage as a result of the AHCA. Using Congressional 
     Budget Office projections of the impact of the House version 
     of the bill, the authors estimated an additional 217,000 
     deaths over the next decade, or 21,700 per year.
       The second piece of evidence Sanders' office cited was an 
     op-ed by yet more health policy specialists who are 
     affiliated with Harvard--David Himmelstein and Steffie 
     Woolhandler, who are professors of public health at Hunter 
     College-City University of New York as well as lecturers at 
     Harvard Medical School.
       The op-ed--published on Jan. 23, 2017, well before either 
     chamber's Republican health care bill was introduced--used as 
     its basis a different study lead-authored by Sommers. This 
     2012 study tracked what happened after states expanded 
     Medicaid.
       Adapting the findings of the 2012 study to a scenario in 
     which 20 million Americans lost coverage--which turned out to 
     be lower than what the CBO found for the House bill--
     Himmelstein and Woolhandler estimated that there would be 
     43,956 deaths annually due to the GOP's health policy 
     changes.
       It's worth noting, however, that both of these projections 
     come from the ideological left. As we noted, the Center for 
     American Progress is a liberal think tank. And Himmelstein 
     and Woolhandler are founders of Physicians for a National 
     Health Program, a group that advocates for single-payer 
     national health insurance--a proposal that is even further to 
     the left than the Affordable Care Act.
       So can Sanders' assertion be supported by the peer-reviewed 
     literature alone?


                         What prior studies say

       In our previous fact-checking of this issue, we found at 
     least seven academic papers that detected a link between 
     securing health insurance and a decline in mortality. Here's 
     a rundown.
       In 2002, a panel of more than a dozen medical specialists 
     convened by the federally chartered Institute of Medicine 
     estimated that 18,000 Americans had died in 2000 because they 
     were uninsured. In January 2008, Stan Dorn, a senior research 
     associate at the Urban Institute, published a paper that 
     sought to update the IOM study with newer data. Replicating 
     the study's methodology, Dorn concluded that the figure 
     should be increased to 22,000.
       A 2009 American Journal of Public Health study concluded 
     that a lack of health insurance ``is associated with as many 
     as 44,789 deaths in the United States, more than those caused 
     by kidney disease.''
       Three studies looked at state-level expansions of Medicaid 
     and in each case found ``significant'' improvements in 
     mortality after such expansions of coverage. These include a 
     2012 New England Journal of Medicine study of New York, 
     Maine, and Arizona by Harvard researchers, and a 2014 study 
     of Massachusetts by researchers from Harvard and the Urban 
     Institute. (These were the two articles that formed the basis 
     of the analyses cited by Sanders' staff.)
       A 2014 study published by the blog of the health policy 
     publication Health Affairs looked at states that, at the 
     time, had declined to expand Medicaid under the Affordable 
     Care Act. It estimated that the 25 states studied would have 
     collectively avoided between 7,000 and 17,000 deaths.
       A 2014 study in the Journal of Clinical Oncology found 
     improved survival rates for young adults with cancer after 
     securing insurance under the Affordable Care Act.
       A 2017 study in the journal Medical Care looked at a 
     provision of the Affordable Care Act that allows young adults 
     to be covered under a parent's policy. The study found a 
     decline in mortality among this population from diseases 
     amenable to preventive treatment. (Mortality from trauma, 
     such as car accidents, saw no decrease, as would be 
     expected.)
       We found two papers with results that were more equivocal.
       A paper published in April 2009 in HSR: Health Services 
     Research. In it, Richard Kronick of the Department of Family 
     and Preventive Medicine at the University of California (San 
     Diego) School of Medicine, raised questions about the 
     conclusions of the seminal Institute of Medicine study from 
     2002. Kronick's study adjusted the data--as the IOM had not--
     for a number of demographic and health factors, including 
     status as a smoker and body mass index, and found that doing 
     so removed the excess number of deaths found in the original 
     study.
       A 2013 paper in the New England Journal of Medicine 
     coauthored by Katherine Baicker of Harvard University 
     compared about 6,000 patients in Oregon who got coverage 
     through a 2008 Medicaid expansion and about 6,000 who didn't. 
     While the study found improvements in out-of-pocket medical 
     spending and lower rates of depression among those who got 
     coverage, key benchmarks for physical health--including blood 
     pressure, cholesterol, and blood sugar--did not improve in 
     such patients.
       But even the two lead authors of the more equivocal studies 
     have told us that the scholarly record demonstrates that 
     having health insurance saves lives, and that not having 
     insurance can lead to additional deaths.
       We asked several of the authors of these papers whether 
     they believe Sanders' assertion of ``thousands'' of deaths is 
     generally supported by the scholarly evidence. We heard back 
     from three of them.
       `` `Thousands' is completely fair,'' Dorn said.
       Baicker agreed. ``It is of course difficult to pin down an 
     exact number of deaths that would be caused by a specific new 
     policy,'' she said. ``But a number like `thousands' does not 
     seem unreasonable, based on the available evidence.''
       And Sommers--whose work formed the indirect basis of the 
     studies cited by Sanders--concurred.
       ``I agree that it's challenging to pin down an exact number 
     on this,'' Sommers said. But overall, the academic evidence 
     ``certainly gets you into the range of thousands of deaths 
     per year.''


                               Our ruling

       Sanders said, ``When you throw 23 million people off of 
     health insurance--people with cancer, people with heart 
     disease, people with diabetes--thousands of people will die. 
     . . . This is study after study making this point.''
       Sanders' statement on Meet the Press was phrased generally 
     enough to be defensible. We found ample evidence in the 
     academic literature to suggest that legislation on the scale 
     of the House bill would produce ``thousands'' of additional 
     deaths.
       That said, we can't say with any specificity how many 
     deaths will occur. It's important to note that the studies 
     provide estimates only, and each study found a slightly 
     different result. On balance, we rate the statement Mostly 
     True.
  Mr. SANDERS. One of the studies my office cited was published on June 
22, 2017, by the Center for American Progress. It was coauthored by a 
Harvard professor of social epidemiology, two medical students who 
graduated from Harvard's T.H. Chan School of Public Health, and two 
policy specialists at the Center for American Progress. I won't go 
through all of the details, but I will say this, quoting from 
PolitiFact:

       The Harvard-Center for American Progress study projected 
     that there would be one excess death for every 830 people who 
     lose coverage as a result of the AHCA.

  The Republican bill.

       Using Congressional Budget Office projections of the impact 
     of the House version of the bill, the authors estimated an 
     additional 217,000 deaths over the next decade, or 21,700 per 
     year.

  That is not Bernie Sanders; that is a study done at Harvard.

       The second piece of evidence Sanders' office cited was an 
     op-ed by yet more health policy specialists who are 
     affiliated with Harvard--David Himmelstein and Steffie 
     Woolhandler, who are professors of public health at Hunter 
     College-City University of New York as well as lecturers at 
     Harvard Medical School.
       Adapting the findings of the 2012 study to a scenario in 
     which 20 million Americans lost coverage--which turned out to 
     be lower than what the CBO found for the House bill--

  They estimated 23 million would lose coverage--

       Himmelstein and Woolhandler estimated that there would be 
     43,956 deaths annually due to the GOP's health policy 
     changes.

  Quoting again from PolitiFact:

       So can Sanders' assertion be supported by the peer-reviewed 
     literature alone?

  Then they cite some studies.

       In 2002, a panel of more than a dozen medical specialists 
     convened by the federally chartered Institute of Medicine 
     estimated that 18,000 Americans had died in the year 2000 
     because they were uninsured. In January 2008, Stan Dorn, a 
     senior research associate at the Urban Institute, published a 
     paper that sought to update the IOM study with newer data. 
     Replicating the study's methodology, Dorn concluded that the 
     figure should be increased to 22,000.
       A 2009 American Journal of Public Health study concluded 
     that a lack of health insurance ``is associated with as many 
     as 44,789 deaths in the United States, more than those caused 
     by kidney disease.''

  And on and on it goes. This is not Bernie Sanders talking; this is 
scientific and medical study after medical study saying what is 
obvious--that if you have a life-threatening disease and cannot get 
healthcare, you will die.
  So I would hope that my Republican colleagues, as they vote tomorrow, 
understand the consequences of their vote. I know no Republican--nobody 
here--wants to see anybody die, but when you take 23 million people off 
of the health insurance they have, many thousands of those people will 
die.
  I think most Americans would think that when you are dealing with an

[[Page S4154]]

issue like healthcare, which impacts, by definition, every single 
person in our country, and when you are dealing with an issue that 
impacts about one-sixth of the American economy--over $3 trillion a 
year--that you just might want to have some serious discussions on that 
issue. You might want to ask--here is a radical idea--doctors what they 
think about this legislation. What is it going to mean to their 
patients? Wow, that is a pretty radical idea when dealing with 
healthcare for all the American people. You might want to have one 
hearing, maybe, and say to doctors: Doctors, what do you think about 
this bill?
  What about hospitals? How will this bill impact hospitals, especially 
rural hospitals in Vermont, Virginia, and all across this country? You 
might want to talk to a hospital administrator. You might want to talk 
to a patient advocate, maybe somebody from the American Cancer Society 
or somebody who is active in the diabetes effort. You just might want 
to talk to the experts on healthcare as to how this legislation might 
impact the work they do. But, amazingly, in an unprecedented way, this 
legislation was written behind closed doors. I think it was 12, 13 
Republican Senators who wrote this bill. Most Republican Senators don't 
even know what is in this bill, let alone Democrats and let alone the 
American people.
  How do you write legislation that impacts every American, one-sixth 
of the economy, and not have one public hearing to hear from those most 
knowledgeable about healthcare in America? But that is exactly what the 
Republican leadership has done. I know why they did that. It is not a 
secret. If you had a horrific piece of legislation, trust me, you would 
want as little public discussion as possible. You would try to hide 
what this bill does. I understand that. Yet, despite all of that, it 
turns out that virtually every major healthcare organization in America 
opposes this bill.
  I don't know how you can go forward with legislation that has had 
zero public hearings, that is opposed overwhelmingly by the American 
people--last poll that I saw from USA TODAY had 12 percent support for 
this legislation--and go forward with legislation opposed by every 
major healthcare organization in America. This bill is opposed by the 
AARP, the largest senior group in America. It is opposed by the 
American Hospital Association, the American Medical Association, 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. In other words, virtually 
every major healthcare organization does not want to see this bill 
passed.
  The American people overwhelmingly do not want to see this bill 
passed. So how come it might pass? People don't want it. Healthcare 
organizations don't want it. Who wants it? I will tell how wants it--
people who are going to get tax breaks. They think it is a great idea. 
Billionaires who got $200 billion in tax breaks from the House bill 
think it is an extraordinary idea. So what if 23 million people lose 
their health insurance from the House bill. The top one percent will 
get $200 billion in tax breaks. Large healthcare corporations like it. 
The insurance companies and the drug companies are going to get a 
combined hundreds of billions of dollars.
  I will tell you who else likes it: those people associated with the 
Koch brothers who are spending hundreds of millions of dollars on 
elections. They like it because their ideology, their philosophy is 
that government should play no role in the concerns of the American 
people. Mark my words--if this bill, which would cut Medicaid by $800 
billion, passes, Medicare will be next. And in the House, they have 
already passed legislation that would voucherize Medicare. Social 
Security will not be far behind. That is the ideology of the Koch 
brothers and the people who fund the Republican Party. Their concern is 
with large campaign contributors, not the American people.
  I hope very much that tomorrow when we assemble here--I gather in the 
afternoon--for a vote, the Republicans will think more about people in 
their own State, about their children, the elderly, the sick, and not 
just about their campaign contributors.
  Thank you very much, Mr. President.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Wisconsin.
  Ms. BALDWIN. Mr. President, I rise this evening to help deliver a 
message from American families to my colleagues on the other side of 
the aisle. The American people have sent a clear message to Washington. 
The message is that they do not want us to go forward with this 
partisan--and mean--healthcare repeal bill. But, incredibly, we are 
today about to embark on a vote to do the exact opposite.
  What is happening in Washington this week is that we are completely 
ignoring the message that Wisconsinites and the hard-working American 
families across this country have sent for us to hear. Haven't you been 
listening?
  To my colleagues on the other side of the aisle, have you been 
listening to the calls pouring in from families in your States? Have 
you been listening to the voices of parents and their children, the 
schoolteachers and doctors, and the working people who are daily 
struggling to get ahead? These messages have been sent to Washington. 
They have been sent loudly and for too many months--in fact, for too 
many months for you to possibly not have heard them. The American 
people don't want to pay more for less care. They don't want the age 
tax or the higher premiums this plan is offering. People with 
preexisting conditions don't want to be thrown into a high-risk pool or 
priced out of the coverage they have today. They don't want bare-bones 
insurance that doesn't cover the essential services and lifesaving care 
they may need. They don't want their loved ones who depend on Medicare 
for nursing home care or their disabled children who rely on Medicaid 
funding at school to have their care put at risk through caps and cuts. 
The American people don't want a plan that will make things worse.
  It is hard for me to believe that Washington hasn't heard this 
message because I have been listening.
  I have been listening to people like Jean. Jean is from Baraboo, WI. 
She told me that she is scared because her Crohn's disease would cost 
her a fortune if her preexisting conditions were not covered. She told 
me that she needs the healthcare she has today because ``my husband 
ruptured a disk in his back that prevented him from getting a job that 
promised us coverage. So now he works multiple jobs.''

  I have been listening to Mary from Kenosha, WI. I met with Mary 
recently, and she told me about her son Kyle. Kyle, at a young age, was 
diagnosed on the autism spectrum and was never expected to learn to 
even speak. When Kyle was 7, medical professionals spoke with Mary and 
said that Kyle might have to be removed from his home and left to be 
cared for in an institution. But Mary had hope, and thanks to Medicaid, 
Kyle was able to receive some very specialized medical therapy for his 
autism, and he was able to remain at home. He was able to receive an 
education. He was able to get his driver's license, and now Kyle is 
attending college.
  Mary is terrified, nonetheless, that this bill's drastic cuts to 
Medicaid would rob Kyle of the care he needs to achieve the 
independence that he has worked so hard for during his entire life. 
Mary told me about her concern for so many other families with similar 
situations.
  I have been listening to Greg. Greg is from Stoddard, WI. He has no 
idea how he and other older Wisconsinites will be able to afford higher 
costs for healthcare. Greg's sons, both of whom have diabetes, are 
already struggling with skyrocketing insulin prices.
  I have been listening to the Schaumberg family in Seymour, WI. Their 
daughter Zoe was born with a congenital heart defect. She had to have 
open heart surgery at 5 days of age. Now, Zoe is guaranteed coverage 
without being denied or charged more, but Zoe's parents are scared that 
this repeal plan will make things worse. When Zoe's mom, Chelsey 
Schaumberg, was told about how this plan would weaken the guaranteed 
protections and care that people have today, she said

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this in her letter to me: ``To me, it's like they're taking the 
American Dream from her . . . kids in Wisconsin with preexisting 
conditions . . . are counting on you to protect that right.''
  This isn't right. This isn't fair. It is not who we are.
  If my colleagues who have been drafting this plan behind closed doors 
have not been listening to the messages of fear and anxiety from the 
American people, maybe they will listen to why this proposal is very 
personal to me.
  When I was 9 years old, I got sick. I got really sick. I was in the 
hospital for 3 months. Following getting out of the hospital, I 
required significant followup care for nearly a year before I regained 
my full strength and fully recovered.
  But when it came to health insurance, it was like I had a scarlet 
letter. My grandparents, who raised me, couldn't find a policy that 
would cover me, not from any insurer and not at any price. They had to 
pay for my care out of pocket, and I can tell you they made some major 
sacrifices to do so, all because I was a child who had been branded 
with those terrifying words ``preexisting condition.''
  So what are we doing here? It is time to stop the partisan nonsense. 
The people of Wisconsin did not send me to Washington to take away 
people's healthcare. They sent me to fight for people like Zoe, Kyle, 
and Jean. What I hear from people in Wisconsin is that they want us 
working together to protect the care people have and to make it more 
affordable.
  We should be working together to lower costs like skyrocketing 
prescription drug prices. We should be working together to strengthen 
the insurance market and give people more options. But we should not be 
working on partisan repeal legislation that will make things worse, 
that will leave millions uninsured, that will make healthcare more 
expensive, and that will price families out of the care they have 
today.
  It is time we listened to the messages that are being sent to 
Washington. It is time we worked together across the partisan aisle to 
do our jobs--the jobs the American people sent us here to do on their 
behalf.
  I hope the congressional majority will join me and my colleagues to 
work together to strengthen healthcare and to move our country forward.
  I thank the body.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Virginia.
  Mr. KAINE. Mr. President, I thank my colleague from Wisconsin and 
also my colleague from Vermont. Their words have been very powerful.
  I also rise to talk about healthcare. We are told in the Senate that 
tomorrow we vote, but we don't know what we will be voting on. We will 
bring up a House bill that, by virtually every account, is not going to 
be the bill that we will be voting on, but we don't yet know which 
version of healthcare we will be voting on if we proceed to the debate.
  It is like a three-card monte game. There are all sorts of different 
versions that are out there on the table. One version would take health 
insurance away from 22 million people, one from 25 million, and one 
from 32 million, and we are not being told which one we will vote on.
  When I was a kid, there was a TV show we used to watch, ``Let's Make 
a Deal.'' One of the features of the show was this: What is behind door 
No. 1, and what is behind door No. 2? The contestants would have the 
opportunity to pick. One would be great, and one would be a disaster. 
That was the fun of the game show: What is behind door No. 1? What is 
behind door No. 2?
  But this isn't about a game show. We are not participating in a game 
show. We are participating in a decision about the most important 
aspect of any person's life--their health--and about the most important 
expenditure they ever make with a dollar--a healthcare expenditure--and 
about the largest sector of the American economy--healthcare.
  Instead of treating the issue with the gravity it deserves, there is 
a secret plan and a mystery vote without any hearings, shutting out the 
committees, including the HELP Committee, where I serve, shutting out 
the minority party, which represents 48 of the 100 Senators in this 
body, and, most importantly, shutting out the public. As the Senator 
from Vermont mentioned, in this body, the greatest deliberative body in 
the world, we have not had a single hearing. We have not heard from a 
single doctor, a single patient, a single hospital, a single nurse, a 
single insurance company, or a single medical innovator. We are about 
to take a vote on the most important expenditure in anyone's life and 
the largest sector in the American economy following a completely 
closed process where it has been the will of the majority to keep the 
door shut.
  This isn't a game show.
  Let me tell you how real this is. I did something on Friday that I 
often do. I started doing this in 2002. I live in Richmond, but I drive 
a number of hours to Wise County, VA, which is a county on the border 
between Virginia and Kentucky. It is a county where my wife's family is 
from. She grew up in Roanoke, but her dad is from Big Stone Gap, VA, in 
Wise County, right across the border from Pike and Hazard Counties in 
Kentucky.
  There is a fairground in Wise--the Virginia-Kentucky fairgrounds. 
Back in the late 1990s, a Catholic nun, Sister Bernie, and two other 
wonderful nurses who have become friends--Teresa and Paula--decided to 
try to offer healthcare for people who didn't have health insurance at 
this county fairground. They just set up with a few volunteers, and 
they said: If you live in Appalachia, if you don't have health 
insurance, if you need medical care or dental care, just come and we 
will see what we can do. They do this every July, for one weekend a 
year.
  Here is what this has grown into. I first went when I was Lieutenant 
Governor in 2002. People start to arrive. I have talked about this on 
the floor. I just did it Friday, and I want to share some stories. They 
start to arrive Tuesday or Wednesday in cars. They camp in the 
campground. Now, it is July, and this weekend was the hottest weekend 
in the summer. They start camping with their kids, often in cars. Some 
are sleeping in cars. Some are throwing blankets out on the lawn next 
to a chain-link fence. They wait in the tens, in the dozens, in the 
fifties, in the hundreds.
  Then they open the door at 6 a.m. It is Friday morning, and the 
people who have waited for days come in and get a number to see if they 
can get healthcare on Friday, Saturday, or Sunday from volunteer 
doctors in the richest Nation and the most compassionate Nation in the 
world.
  When they opened the door on Friday morning, I was down there. I do 
what I do. I go and I work the registration booth, and I talk to people 
and register them so they can get healthcare. I got there a little 
late. They had opened the door at 6 a.m., and I got there 8 a.m. They 
had already given out numbers to 1,200 people in the first 2 hours. 
Over the course of the weekend, they serve thousands of people.
  They come in to get dental care. For most of them, their teeth are 
too far gone. So it is just a matter of pulling their teeth. Some come 
in to have most of their teeth pulled, and then they can get dentures. 
They get an eye exam and find out: Wow, I should have gotten glasses 5 
or 10 years ago. No wonder I have been such a poor student all the way 
through school, or no wonder I have had such a hard time on my job. I 
needed glasses.
  They get a cancer screening. Sometimes they get something caught 
early, and sometimes they get something caught very late.
  It is an amazing spectacle. It is uplifting because of the volunteers 
who turn out--doctors, dental hygienists, nurses, and the Lion's Club, 
which comes to do vision screenings. That is uplifting.
  It is depressing and it is heartbreaking to see people sleeping up 
against chain-linked fences and sleeping crunched over in their car for 
days so that they can get a little bit of free healthcare in the 
richest Nation on Earth.
  When I work the registration booth, I have to ask people a series of 
questions so that they know who they can go see when they are there. I 
worked the booth for about an hour and a half. Here is a question you 
ask everybody: How long has it been since you have seen a doctor? How 
long has it been since you have seen a doctor?
  I had a mother of four kids. The kids were 12 and under, and they 
were sort

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of buzzing around. The mom was sitting in a chair. You know what 
happens if you are a mom with kids that young. Your kids pick up 
something in school. They bring it home, and you get sick. This is what 
happens to parents. I have a colleague here with young kids, and he 
knows what I am talking about.
  I asked the mother: How long has it been since you have seen a 
doctor?
  I am not really sure.
  So I was kind of going through my checklist. Have you seen a doctor 
within the last year?
  No, not within the last year.
  Have you seen a doctor within the last 2 years?
  Not within the last 2 years.
  Have you seen a doctor within the last 3 years?
  I might have seen a doctor in the last 3 years.
  That was a mother of four young kids.
  I had somebody sitting across from me, and I asked her another common 
question: Are you employed? You ask everybody this. Part-time? Full-
time?
  I am not employed, but I am about to get my nursing license back.
  Well, that is interesting. So you are in healthcare.
  Well, I used to be. I am about to get my nursing license back.
  Well, what happened?
  Now, this wasn't on the questionnaire, but I couldn't resist asking 
her: What happened?
  Well, I was a nurse. I had a great career. I had a great life. But 
then a doctor prescribed me opioids for arthritis, and the bottom fell 
out of my life. I got addicted to opioids, and I lost my license, and I 
lost virtually everything in my life. Now I am unemployed, but I am 
working as a counselor at a church, trying to help people who are also 
opioid addicted. I am about to get my license back, but I am not 
working yet, and I don't have insurance yet, and that is why, even 
though I am a nurse and I am a healthcare professional, I have waited 
in line for a couple of days to come get healthcare.
  There was a woman from Maryland who had been laid off as a supervisor 
at McDonald's a number of months ago. She was unemployed. She had 
horrible dental problems that were way past being solved. She just 
needed to get a bunch of her teeth pulled to ease her pain. So get what 
this woman did. This is about an 8 or 9 hour drive from her house. When 
her teeth got so bad and so painful after her firing and she needed to 
have her teeth pulled, she couldn't go anywhere. She didn't have 
anybody to do it.
  She said: I think there is this free clinic in Appalachia. Now, it is 
a couple of months out. So I am going to have to suffer through the 
pain for a while, but I also have to save up some money.
  She saved up her money like most people would try to save money for a 
summer vacation. She saved up her money so she could put enough gas in 
the car and pay for one night at a hotel and so she could drive for 9 
hours to Wise County, VA, and wait in the line for days and come and 
get a bunch of her teeth pulled in the richest and most compassionate 
Nation on Earth.
  By the way, I had another guy, and I asked him the question: What are 
you here for? Are you here for medical services, are you here for 
dental services or are you here for vision services?
  He said: I am actually here for all three, but the problem is, it is 
the hottest day of the year. It is 95 and humid, and I am so sick, I 
can't sit out in the Sun all day. So I got to do two out of three. I 
can't do all three.
  I said: Which are the two worst, is it the medical and dental or 
vision and dental or vision and medical? He said: Look, I will do 
dental and medical, but even though I have glasses and I need to get an 
upgrade, I can't wait around because I am so sick out in the hot Sun 
for so long. So you are just going to have to give me two out of the 
three. I can't wait all weekend. I can't wait all day in this dusty 
fairground on the 21st of July to get healthcare.
  These people need us. They need us to be at our best. They need us to 
be thinking about them.
  The first time I went to this clinic in Wise, I was struck by the 
magnanimity of the volunteers, I was struck by the need, but what 
really hit me was when I went into the parking lot. I expected to see 
cars from Virginia and Kentucky because Kentucky is 10 miles away from 
the fairgrounds. I might have expected to see cars from West Virginia, 
which is 100 miles away, or Tennessee, which is 40 miles away, but 
North Carolina is 150 miles away, South Carolina is 350 miles away, 
Georgia is 400 miles away, Alabama is farther, and Oklahoma is farther. 
People drive from all over the Southeast in the United States, in the 
richest nation on Earth, in the most compassionate Nation on Earth, to 
wait for days in a dusty campground in the heat of the hottest part of 
the summer so they can have their teeth pulled because they don't have 
healthcare.
  The Affordable Care Act has cut the uninsurance rate to one of the 
lowest in recorded history, but we haven't gone far enough. We have to 
do better by these people who are sleeping in their cars or up against 
chain-link fences, who are traveling for 9 hours to get their teeth 
pulled, not worse. We want to have fewer people like this and fewer 
folks who need to do this, not more.
  The vote we are going to have about whether it is 22 million or 25 
million or 32 million people who lose health insurance, that is going 
the wrong way. We have to go a different way. We have to do better, not 
worse.
  Most of the things we talk about in this Chamber are about issues. 
This isn't about issues, this is about who we are. This is about who we 
are as Senators. This is about who we are as Americans. This is about 
who we are as thinking, feeling, breathing, believing human beings. It 
is about who we are.
  A great teacher, a great teacher once laid out the yardstick: ``I was 
sick and you took care of me.'' That is one version of the New 
Testament. There are other phraseologies from the 25th chapter of 
Matthew: I was sick and you visited me. I was sick and you cared for 
me. I was sick and you looked after me. The Teacher basically says, the 
way you treat someone who is sick is the way you treat the Creator.
  It is important to be compassionate to somebody who is sick, and 
anybody who is hearing these words, you don't have to think for a 
second to think about somebody in your family who is suffering from 
cancer or dementia or mental illness or who has been the victim of an 
accident. There are faces appearing in your minds right now because we 
all have this in our families. The way we treat people who are sick is 
not just a measure of us, it is a measure of what we think about the 
Creator. When a great teacher said, ``I was sick and you took care of 
me,'' he was giving an instruction to us about the way we should 
behave.
  In the last week, I am struck by the fact that this body has been 
jolted by the news about two of our colleagues, both of whom who have 
had cancer diagnoses. Last week, we were shocked and saddened to hear 
about our colleague from Arizona, Senator McCain, who is my chairman on 
the Armed Services Committee who is suffering a very tough form of 
cancer, and cancer is going to find a match in Senator McCain.
  This touches us in this body. A week or two before, we heard about 
another colleague on the Armed Services Committee who sits next to me 
at every committee hearing, Senator Hirono, who just announced she has 
kidney cancer and just underwent surgery. I was chatting on the floor 
with her earlier tonight. I don't think she would mind me saying, she 
is strong and she is a fighter, like Senator McCain is a fighter, but 
she is worried about it just like Senator McCain would be. This touches 
everyone.
  It touches the powerful, it touches the powerless. It touches the 
wealthy, it touches the poor. It touches men, it touches women. It 
touches the young, it touches the old. It touches everyone, and the way 
we treat people who are sick, the way we treat people who are anxious 
about their health is the way we treat the Creator. That is what we are 
taught. So let's live up to that standard.
  Why would we do otherwise? Why are we here? Why did we run? Why do we 
serve? What do people expect of us? I was sick, and you cared for me. I 
was sick, and you visited me. I was sick, and you looked after me. I 
was sick, and you took care of me.
  Is it that hard? Is it so important to rush it through and not have 
hearings and not have committees and not engage the Democrats and not 
listen to

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the people sleeping against chain-link fences or driving 9 hours to get 
their teeth pulled?
  We can't afford to get this wrong, and the talent of the people in 
this body convinces me beyond a shadow of a doubt that if we take the 
time, we can get this right. If we can get this right, why will we not 
take the time to get this right?
  So I would plead with my colleagues, let's stand together on behalf 
of the sick, let's stand together on behalf of those who are counting 
on us.
  Another part of the New Testament is the Letter of Paul to the 
Hebrews: ``Because we are surrounded by such a great cloud of 
witnesses, we have got to do the right thing.'' We are surrounded by a 
great cloud of witnesses who want us to do the right thing, and I know 
we can, and I pray we will.
  With that Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Connecticut.
  Mr. MURPHY. Mr. President, I was really glad to be on the floor to 
hear the remarks of my great friend Senator Kaine.
  It is gut-check time in the U.S. Senate. The legislation we are going 
to consider tomorrow would hurt a lot of people in ways I think that 
are very hard to fathom. One of our colleagues said: I didn't come here 
to hurt people.
  Everybody came here with designs on how to make their community, 
their State, their Nation a better place, and we are on the verge of 
taking a vote on a bill that objectively will rain a level of 
devastation down on this country that is really hard to fathom.
  I can't match Senator Kaine's eloquence talking about the personal 
stakes here. We take for granted the fact that as employees of the U.S. 
Senate, we get a health benefit that makes sure that if we do fall ill 
or if our children fall ill, we will not have to think about whether we 
have the money to be able to afford treatment, but that is not how it 
is for all of those families who lined up in Virginia to receive care. 
That is not how it is for those who come to a similar event in 
Connecticut that is targeted just for dental services but has a line 
that begins the night before and is oversubscribed before the event 
begins the next morning.
  That is not how it was for the millions of American families who used 
to go bankrupt because, when faced between a choice of personal 
financial ruin and the death of a child or a loved one, they chose 
financial ruin. Until you have been faced with that choice, I don't 
think there is any way to understand it. It certainly is a choice no 
one in this Chamber will ever have to make.
  In Connecticut, the Burger family made that choice. Before the 
Affordable Care Act was passed, in the 2-week period of time where Mr. 
Burger didn't have healthcare insurance, their son was diagnosed with 
cancer, and when he got on his new plan, it was a preexisting condition 
so it wasn't covered, and the Burger family lost everything. They went 
through their savings account. They lost their house. They went 
bankrupt. They were one of thousands and thousands of families who made 
that choice. That rarely happens any longer. The number of personal 
bankruptcies in this country has been cut in half because of the 
Affordable Care Act.
  The Affordable Care Act hasn't made healthcare magically affordable 
for everyone, but it has meant that people don't have to make that 
choice any longer. The scope of the pain we are talking about, if any 
of the three versions of this bill get the vote, is really hard to 
fathom. Under the original version of the bill, 23 million people would 
lose insurance.
  I amended this chart when a series of changes were made at the last 
minute that CBO scored to reduce that number to 22 million, but this is 
the entire population of Alaska, Delaware, Hawaii, Idaho, Kansas, 
Maine, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North 
Dakota, South Dakota and West Virginia, all losing healthcare at the 
same time, and the majority of that happens in the first year. So of 
the 22 million, 14 or 15 million of those people lose insurance next 
year. The scope of that devastation--12 months from now, 15 million 
less people having insurance, 15 million more people showing up in 
emergency rooms to get care--is something I don't think any of my 
colleagues really can get their head wrapped around.
  For all the times President Trump said the Affordable Care Act is 
dead, that ObamaCare is in a death spiral, that is not true. It is a 
lie. It is a lie because the Congressional Budget Office says the death 
spiral only occurs if you pass any of the versions of the legislation 
we are considering; that if the Affordable Care Act stays in place, 28 
million people will not have insurance--which is far too many--but if 
one of these bills go into effect, at the end of 10 years, we will have 
50 million people without insurance.
  A new report from the Kaiser Family Foundation found that the ACA 
markets are not collapsing despite what the White House says--despite 
the lies they perpetuate. Early results from 2017 suggest the 
individual market is stabilizing and insurers in this market are 
regaining profitability. ``Insurer financial results show no sign of a 
market collapse.'' That is the Kaiser Family Foundation's finding which 
mirrors the finding of CBO.
  The collapse in our insurance market only happens if one of these 
bills pass, and it is not just the number of people who lose 
healthcare. The folks we should care most about--the people who are 
making just enough money so they don't qualify for Federal programs but 
not enough money that they can save for retirement and pay for their 
kids' college bills and do all the things you need to do in order to 
lead a respectable life--those people are going to be hurt worst by 
this bill.
  If you are a 64-year-old getting ready for Medicare coverage, you are 
making $56,000 a year, you are going to pay 170 percent more under this 
bill just in your premiums, never mind the extra money you are going to 
pay in copays and deductibles.
  The CBO says that if these bills are passed, a single policyholder 
who purchases a plan at a 58-percent actuarial value in 2026 would have 
a deductible of roughly $13,000 for medical and drug expenses combined, 
which is absolutely unaffordable.
  By every metric, whether it be the amount of money that you pay or 
the number of people who do not have healthcare coverage, the CBO 
answers this question: Who gets hurt under the GOP healthcare plan? 
Pretty clearly, everybody, unless you are an insurance company, a drug 
company, or rich. If you are affluent and you can afford your own 
healthcare, you will be fine. If you are an insurance company or a drug 
company, you are going to get a big tax cut out of this. But everyone 
else will get hurt and get hurt really badly.
  I have watched my Republican friends process this information. I have 
watched them, largely, stay silent. The Democrats are the only people 
on the floor of the Senate these days who are talking about healthcare. 
Most of my Republican friends are not willing to come down and defend 
any of these products, but those who have been have shifted their 
rationale.
  Republicans who have been willing to come down and defend their plan 
concede that millions and millions of people will lose insurance, and 
they concede that rates will go up for most Americans. So they cling to 
one last value that underpins the Republicans' healthcare plan. In 
their words, that value is freedom--the freedom not to be insured. The 
Republicans suggest that you should not really worry about 32 million 
people losing insurance because those people really did not want 
insurance and now they will be free not to have it. That is just not 
what the CBO says. The CBO says that millions and millions of these 
people who will lose insurance desperately want it; they are just not 
going to be able to afford it.
  It is also not true that the bill grants that kind of freedom. 
Insurance is compulsory under the Republican healthcare plan just like 
it is under the Democratic plan. It is just compulsory in a different 
way. The Republican plan says that as a penalty for not having 
insurance, you will be banned from purchasing insurance for 6 months. 
The Affordable Care Act says that if you do not purchase insurance, you 
will get a penalty on your tax form. Either way, it is a penalty.
  Yet a new wrinkle has been thrown into this debate because last week 
it was ruled that, in a reconciliation, the Republicans cannot include 
this penalty provision. Without it, the entire

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bill falls apart. Markets would collapse.
  For all of the Republicans' talk about the freedom not to purchase 
insurance, they included a requirement in their bill that people buy 
insurance. They know they had to because they know that without it, the 
entire insurance market would collapse. Why is that? If you require 
insurance companies to charge the same thing for sick people as for 
non-sick people, then you have to encourage people who are not sick to 
buy insurance. If you do not, folks will just wait until they are sick 
to buy insurance, and the only people who will have insurance will be 
the people who have acute conditions. That will make insurance itself 
unaffordable, and insurers will stop offering products, or they will 
jack up rates to the point that it will be totally unaffordable for 
everyone.
  In the Affordable Care Act, that is what led to the individual 
mandate. In the Republican healthcare bill, that is what led to this 
provision that locks you out of insurance for 6 months. But that has 
been ruled veritable. That has been ruled essentially out of order 
under reconciliation.
  The Republicans are going to be faced with a choice if they are able 
to get on this bill. They will either remove that provision and 
guarantee the collapse of the entire insurance market in this country 
or they will have to strengthen that penalty in order for it to be 
allowed under reconciliation, but that will essentially rob the last 
rhetorical argument that the Republicans had in favor of this bill. 
They cannot argue that it provides more people with insurance. They 
cannot argue that it helps with cost. They cannot claim that it 
increases quality. They know that. The only thing left that they could 
argue is that it allows some people to go without insurance if they do 
not want it. In truth, their bill does not do that, and the rules of 
the Senate are going to require that they increase that penalty even 
more if they want any plausible, workable version of this bill to 
survive.
  It leaves us in a place in which there is no argument to do this. It 
does not advance values that Republicans hold dear, like personal 
freedom, it does not improve people's healthcare experiences, and it 
does not increase the number of people who have healthcare insurance.
  It really does beg the question: Why are we doing this? Did anybody 
come to the Senate with the desire to hurt this many people?
  If I had told my Republican colleagues 4 years ago that their ACA 
replacement plan was going to drive up the number of people without 
insurance by 32 million and increase rates by 20 percent in year 1, 
would you have believed it? No. For 6 years, I took my Republican 
colleagues at their word. I did not agree with them that we should 
repeal the Affordable Care Act, but at least I thought they had the 
same goals in mind as we did--more people having access to the 
healthcare system and costs being controlled for as many people as 
possible. It is now clear that we do not. The Republicans are about to 
vote on a bill that will inflict unthinkable amounts of pain on this 
country. Who gets hurt under the GOP health plan? Everybody.
  I said this on the floor last week, and I will just say it again to 
close--that it does not have to be this way. We have accepted for so 
long that healthcare is a political ping-pong ball that gets tossed 
from one side to the other every 5 or 10 years.
  Why is it so inconceivable that Democrats and Republicans could not 
sit down together and try to work out keeping the parts of the 
Affordable Care Act that are working and improving the parts that are 
not? Why couldn't the Democrats understand that the Republicans want 
flexibility of benefit design and give Republicans something on that if 
you understood that we want some certainty of these marketplaces? We do 
not want President Trump to be able to sabotage and undermine these 
markets. Why can't there be a compromise and a deal there?
  There is still time. If this vote fails tomorrow, there is still the 
ability for us to come together, because in the end, there is the story 
Senator Kaine told about rural Virginia. Everybody here knows that 
story. Everybody here knows there is enormous work still to be done, 
and nobody out there is believing the lies about this bill, this 
wonderful healthcare plan President Trump is promising. Everybody in 
this country hates this bill. It has a 15-percent approval rate. These 
folks know there is virtually no one who is helped by this bill other 
than insurance companies, drug companies, and people who are very 
affluent and fortunate enough to be healthy.
  We do not have a communicable disease on our side of the aisle. We 
are not going to physically hurt you if you get in a room with us. We 
actually do deeply desire to improve the healthcare system. You have 
just got to give us a chance.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. MERKLEY. Mr. President, I rise to address the Republican plan to 
have a vote to proceed to a healthcare bill tomorrow. The only 
challenge is that we have no idea what bill we are being asked to 
proceed to. This is hardly the way a democratic republic operates in 
which the leader of the majority says: We want to come to the floor 
with no committee deliberation, no consultation with healthcare 
experts, no dialogue with the public, no amendments in committee of any 
kind, and vote on a mystery bill.
  The biggest mystery to me is how it is possible that the majority of 
Republicans are taking seriously a plan to rip healthcare from 20 
million-plus Americans in order to give fabulous giveaways to the 
richest among us. The bill they entertained previously would have given 
$33 billion to the richest 400 Americans--$33 billion. I have mentioned 
this number before. Some journalists have quoted it as $33 million, and 
some citizens have said that I meant $33,000. No. It is $33 billion to 
the richest 400 Americans--enough funds to pay for Medicaid for 700,000 
people.
  What individual would say it is moral to rip healthcare away from 20 
million people in order to give tax breaks to the very richest among 
us? In some misguided, mysterious way, something has gotten ahold of 
the hearts and minds of my colleagues and made them think this was some 
kind of good idea to do so much damage to so many.
  In fact, we have been having this conversation since January. It was 
earlier this year, when President Trump was sworn in, when the majority 
said: We are going to come to the floor of the Senate, and we are going 
to repeal healthcare for millions of Americans in short order.
  Here we are 6 months later, and it has not happened yet--in part 
because when people look at the details, they start to raise questions.
  It took a long time for the House to send a bill over to the Senate, 
and then the Senate proceeded to work on this bill with a group of 13 
secret Senators--working in a secret room, in secret meetings--with the 
public not allowed, with fellow Senators not allowed. They came up with 
a bill that looked very much like the House bill, and we will talk more 
about that later.
  The President said in his campaign and throughout much of this year: 
You are going to have such great healthcare at a tiny fraction of the 
cost, and it is going to be so easy.
  Well, it has not been that easy. We have seen the President back a 
plan from the House and invite everyone over to celebrate at the White 
House and get the champagne bottles out and say how wonderful it was 
that the House had passed this healthcare bill--this bill that would 
strip healthcare from more than 20 million Americans. Then, a couple of 
weeks later, someone explained to him what was in that bill, and he 
said: Oh, well, that bill is mean and heartless. Then the secret 13 
here in the Senate meet, and they come out with a very similar bill. 
And now Trump is all excited; now we have a really good bill, except 
that in a single year, it would do even more damage to healthcare in 
America.

  Along the way, the President moderated his dialogue a bit and said: 
Who knew healthcare could be so complicated? Well, Mr. President, most 
of the people in America realize we have a complicated healthcare 
system. We have an overlapping system of six different systems of 
healthcare. It really is quite messy and difficult. It would be great 
if we could, in fact, adopt a much simpler system. And I certainly have

[[Page S4159]]

been advocating for us to have a much simpler system, so just by right 
of being an American, you are born into this world and you have 
healthcare. That is the way most developed nations do it, but not here 
in the United States of America. We have a great healthcare system for 
the very wealthy, and we have a very complicated, stressful system for 
everyone else.
  What are we going to vote on tomorrow? I wish the majority leader 
would come to the floor and tell us. Will we vote on a motion to 
proceed to a bill that looks like--what? What can you tell us? Is it 
TrumpCare 3.0? How does it differ from TrumpCare 1.0 or 2.0? Will it 
have the Cruz amendment in it for fake insurance, the provision that 
would do enormous damage on both ends of the insurance market, 
providing fake insurance policies to the young and the healthy and 
destabilizing healthcare and putting it into a death spiral for 
everyone else? Or, Mr. Majority Leader, maybe you could come and tell 
us if you are planning a straight repeal of the ACA--a straight repeal 
that would raise costs and premiums even higher and not just rip 
healthcare from 20-plus million people, but from 30 million-plus 
people, a plan that would be even more devastating than the previous 
plan. Is that what you want us to vote to proceed to tomorrow?
  I can tell you that we shouldn't be voting to proceed to any version 
on healthcare, something that so affects the peace of mind and the 
quality of life of Americans. We should be operating like a democracy, 
like a democratic republic--holding committee hearings, holding a 
conversation. This is what we did when we talked about the ACA those 
several years ago. We had more than 100 committee meetings, 
roundtables, and walk-throughs here in the U.S. Senate. We had the 
single longest markup of a healthcare bill in the HELP Committee ever 
in the history of the United States. We had the second longest session 
marking up the bill in the Finance Committee. We had the entertainment 
of hundreds and hundreds of amendments, and we adopted over 100 
Republican amendments. There was a very public, extended process, with 
a ton of time to go home and consult with healthcare experts and 
stakeholders in our own States and with the most important 
stakeholders--the citizens of the United States of America--the men and 
women and sons and daughters and grandparents. How did they feel about 
these changes?
  Well, as everyone knows, President Trump did call the House bill mean 
and heartless, but we just keep getting bills that are meaner and more 
heartless. The House bill would kick 23 million people off insurance 
over the next decade and 14 million just next year. The subsequent 
bills don't look that different.
  The secret 13 here in the Senate went and did their deliberations, 
adopted pretty much the same thing as the Senate, only they made it 
worse. That June Senate bill would kick 15 million off in a single 
year, rather than 14 million. And then we had the brilliant idea of a 
repeal-only bill, which would do even worse, kicking 17 million people 
off in a single year and 32 million off within the 10-year period.
  Then we have the bill that isn't even on here because we didn't get a 
Congressional Budget Office score on it; that is, the special Cruz fake 
insurance amendment bill--the one that would say: Hey, insurance 
companies, you can offer policies that are not worth the paper they are 
written on. Oh, they are very appealing. There is a health insurance 
policy. You only have to pay $40 a month. Isn't that great? And then 
the policyholder who has it, they get in a car accident, they get a 
broken bone, and they find out the emergency room is not covered, the x 
rays are not covered, the cast is not covered, the doctor is not 
covered. Nothing is covered. That is why it is fake insurance. That is 
why it costs only $40 a month. It might as well be 40 cents a month, 
for all we care, because it just doesn't cover anything.
  Then, your spouse--your wife--has the great, joyful news that you are 
going to have a child together, and guess what. Maternity care is not 
covered. Can you imagine in this modern era not covering maternity 
care? Yet, before the Affordable Care Act, many, many policies in 
America didn't cover maternity care.
  Well, in addition, these brilliant plans by my colleagues would cause 
premiums to skyrocket. Then, we have, of course, the fact that they do 
diabolical things to those who have preexisting conditions.
  Now, let me spend a little more time on the special Cruz fake 
insurance version of this. Yes, it gave those very cheap policies that 
aren't worth the paper they are printed on to the young and the 
healthy. But then, those who are older--those who are sick or have 
injuries or have preexisting conditions or are concerned that they may 
develop difficult medical issues--they need to buy a policy that 
actually covers the things that one would expect, that has an essential 
benefits package, the same as every single policy in America today has. 
But, because the young and the healthy are buying the fake policies, 
that means that the costs skyrocket on the policies with the essential 
care benefits. As a result of that, more people bail out who feel like 
they are not directly in danger of getting sicker or injured, and then 
the cost of the policy goes up even more. It is a death spiral 
for insurance: fake insurance at one end, destruction of the insurance 
market at the other end.

  So my colleagues decided to not even share the Congressional Budget 
Office analysis of that bill. It was that bad.
  Let's see what some folks said about this. Larry Levitt, senior Vice 
President of the Kaiser Family Foundation said: ``If there were a Joy 
of Cooking for insurance, this would be the perfect recipe for 
destabilizing the market and turning the marketplaces into high-risk 
pools.''
  That is his comment about the Cruz fake insurance plan.
  Let's turn to a joint letter from Blue Cross Blue Shield and from 
America's Health Insurance Plans about the Cruz insurance plan, the 
Cruz fake insurance plan. Their letter says: ``It is simply unworkable 
in any form and would undermine protections for those with pre-existing 
medical conditions, increase premiums and lead to widespread 
terminations of coverage for people currently enrolled in the 
individual market.''
  Or how about an article in the Atlantic by Vann Newkirk, published 
just a week ago, July 14 of this year: ``The Cruz amendment creates 
almost a textbook scenario of wide-scale adverse selection--whereby 
riskier and more expensive patients wind up concentrated in risk 
pools--and entirely undermines any tools for managing that adverse 
selection.''
  That is a fancy way of talking about the death spiral in insurance 
for those who are not young and healthy.
  Then we go to the conversation that CBO says is the worst option of 
all: 17 million would lose coverage in the first year and 32 million by 
2026 under the repeal-only plan. Next year, in just 1 year, premiums 
would skyrocket above what they might have gone to anyway by an 
additional 25 percent.
  Now, our majority leader likes to say that wouldn't actually happen 
because provisions in the bill don't go into effect for 2 years. Well, 
these estimates and these commentaries take that into account, because 
the destabilization in the marketplace begins immediately. Does anyone 
really think insurance companies are going to stick around the 
marketplace that they don't know is going to exist in 1 or 2 years?
  This repeal-and-run strategy would throw our healthcare industry into 
chaos. If you think it is a good plan, well, I have some beachfront 
property in Arizona you might want to buy.
  Every version of this Republican TrumpCare plan is worse and worse 
for the American people, yet these are the options that are being put 
forward. The majority leader wants us to vote to proceed to this set of 
undesirables tomorrow, these undesirable--in fact, ``undesirable'' is 
just too kind of a word for these policies. These are despicable. These 
are destructive. These are, as the President said, mean and hard-
hearted.
  Shouldn't we try to pursue options that will make our healthcare 
system work better? That is what we need to do. Let's start by nailing 
down the cost-sharing reduction payments, or CSRs. These payments are a 
lifeline to more than 12 million low-income Americans. They lower the 
premiums, and they lower the deductibles. They are important sources of 
stability for

[[Page S4160]]

insurance companies. But our President has said: I am not sure I want 
to release these CSR payments. So what happens with that? Insurance 
companies have to assume they are not going to get them, so they are 
raising their rates or perhaps bailing out of the market completely.
  If these CSR payments are terminated, insurers may leave these 
exchanges altogether. For those who do stay in, the average premiums 
for silver plans would need to increase by 19 percent just to 
compensate for the loss of the CSRs. Because insurance companies are 
like any other business, they need to know how much they are going to 
be paid if they provide a product, and right now, they don't know.
  Let's hear what some have had to say. When the insurance company 
Anthem pulled out of Ohio in June--last month--the company cited 
``continual changes in Federal operations, rules and guidance'' as the 
main reason for exiting the marketplace.
  The company also said that ``the individual market remains volatile 
and the lack of certainty of funding for cost sharing reduction 
subsidies . . . does not provide a sustainable path forward.''
  Then there is Brad Wilson, the president of Blue Cross Blue Shield of 
North Carolina, who said:

       The biggest single reason for that rate increase is the 
     lack of the federal funding for Cost Sharing Reduction 
     Payments in 2018. We cannot assume nor should we that the 
     money is going to be there based on what we know today.

  At another point Mr. Wilson was quoted as saying:

       The failure of the administration and the House to bring 
     certainty and clarity by funding CSRs has caused our company 
     to file a 22.9 percent premium increase, rather than one that 
     is materially lower. . . . The rate increase would be 8.8 
     percent if the CSRs were guaranteed for 2018.

  A single-digit increase versus more than a 20-percent increase, and 
they have to go with the higher increase because they don't know if the 
President is going to make the payments that he is obliged to make.
  I think a piece from the Baltimore Sun from May 5 describes the 
situation we find ourselves in best, when it says:

       It's not the problems in the Affordable Care Act exchanges 
     that are driving the Republican effort to repeal Obamacare. 
     It's the Republican effort to kill Obamacare that's causing 
     problems in the exchanges.

  President Trump and the Congressional Republicans are trying to 
exacerbate them. He closes by saying: ``No wonder rates are going up.''
  This really does make clear the situation. The President wants to say 
the exchanges have problems so we need to repeal and run or repeal and 
replace. Our answer to the exchanges having problems is to drive 20 
million people-plus off healthcare, maybe 30 million people off 
healthcare. In fact, the exchanges are having problems because they are 
being sabotaged by President Trump and our Republican colleagues; 
first, by wiping out the reinsurance proposal, which enables companies 
to go into a new area and compete but only if they have insurance 
against getting a disproportionate share of the really sick people. 
That is a very logical part of an insurance plan which encourages 
companies to go into new markets to compete, and my colleagues 
sabotaged it.
  The cost-sharing reduction payments we just talked about, a very key 
part of lowering premiums and making the policies affordable so 
struggling, hard-working Americans can buy those policies and have 
lower premiums and lower deductibles, but my colleagues and President 
Trump have sabotaged it.
  That is not a service to the American people. Maybe they feel they 
are doing a service--to whom? To the rich who can buy insurance without 
any of this effort to provide insurance throughout our society. Do my 
colleagues really want a world in which we only have wealth care? That 
is healthcare that only the wealthy can buy. Do they really want to 
denigrate, tear down, and destroy the quality of life of millions of 
their constituents by pursuing this path?
  It was not that long ago that Franklin Roosevelt said: ``The test of 
our progress is not whether we add more to the abundance of those who 
have much, it is whether we provide enough for those who have little.''
  But in their bills, my colleagues have been saying: We want to give 
massive tax giveaways to those who have the most by ripping healthcare 
away from those who are struggling, hard-working Americans.
  It is the opposite. It is the opposite of the belief that we are all 
in this together, and we want a foundation for every family to thrive. 
I want a foundation for every family to thrive. That means peace of 
mind that if your loved one gets sick, they will get the care they 
need. It is the peace of mind that if your loved one gets sick, they 
will not end up bankrupt.
  We are not just talking about ripping healthcare insurance away from 
more than 20 million people. We are talking about ripping peace of mind 
away from 20 million people. We are not just talking about those 
individuals. We are talking about undermining the rural and urban 
healthcare infrastructure which helps everyone.
  I have been out in very rural, Republican parts of my State holding 
townhalls. I am hearing from those who are in clinics, and they have 
improved considerably. Some of them have doubled their number of 
employees over the last 8 years because of the support for healthcare 
clinics in the ACA and also because their uncompensated care--the 
number of people they were serving who couldn't pay their bills--has 
dropped enormously.
  So not only have they been able to employ a lot more people providing 
healthcare in the community, but they have been able to do additional 
things. They have been able to provide more preventive services, more 
mental health services, and so forth. So it has been a big win for 
rural America, and my colleagues want to tear that down. That just 
doesn't make any sense at all.
  That is why everyone here should vote unanimously to oppose going 
onto a mystery healthcare bill tomorrow. There is so much we could do 
together if we want to improve healthcare: fix those CSRs; provide a 
fix to reinsurance; proceed to have a full enrollment period rather 
than cutting it short; retain and reinforce the individual mandates so 
those who have insurance are covered throughout the spectrum, from the 
young and healthy to those who are older; provide the sort of 
advertising that enables people to sign up and make the signup process 
a lot easier than it is right now. There is so much we can do together 
to make our healthcare system work better.
  My colleagues have come to the floor tonight to say this really 
matters. Quit playing games with people's lives, quit trying to destroy 
the foundation for our families to thrive, and vote no on a motion to 
proceed to a mystery healthcare bill tomorrow.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Hawaii.
  Mr. SCHATZ. Mr. President, the Senate Republicans are about to take 
one of the most reckless actions in Senate history. They are going to 
vote to blow up the American healthcare system and do I don't know what 
next.
  I want to be really clear about this. Never before has the Senate 
voted on major legislation that would reorder one-sixth of the American 
economy and impact tens of millions of American families without even 
knowing what the bill does. There has been no bipartisanship. There 
have been no hearings.
  Let me just say something about hearings. This may seem like sort of 
a process or procedural complaint, but this very much matters. Hearings 
matter because it is how you get experts to tell you whether your bill 
is any good, whether it is smart or stupid, harmful or helpful. 
Hearings matter because they subject your bill and the process to 
public scrutiny. The media is able to report on what you are up to, and 
your constituents know what you are up to. So it is not a small thing 
to complain about no hearings. In fact, you can't be a good legislator 
without having hearings, and you can't be an effective legislative body 
without conducting public hearings. We never have major legislation 
without hearings, but that is exactly what they are doing, and there is 
one very simple reason for this. They are embarrassed by what is in 
this bill.
  It is true we don't know exactly what is in this bill. There are lots 
and lots of versions and lots of notions being kicked around, but we 
can be sure of a few things.

[[Page S4161]]

  First, we know this; that whatever problems there are with the 
Affordable Care Act, this bill doesn't even bother to try to fix them. 
To the extent that people are worried about high deductibles, it 
actually increases the deductibles. To the extent that people are 
worried about the lack of choices on the healthcare exchanges, it 
doesn't even try to fix that.
  Second, we don't know exactly how much they are going to cut 
Medicaid, but they are going to cut Medicaid. Whether it is rolling 
back the Medicaid expansion or making these radical structural reforms, 
essentially block-granting Medicaid to the States, they are going to 
deeply cut Medicaid. This hurts people. It hurts people in nursing 
homes. It hurts people with drug addiction. Medicaid is a program that 
works and delivers care for millions of Americans, and it will be 
slashed massively tomorrow.
  We also don't know whether they are going to keep the capital gains 
tax cut or get rid of it. In any case, they are going to get rid of 
most of the revenue in the Affordable Care Act. They are cutting taxes 
for the very wealthy, and the way they pay for that is to cut Medicaid. 
So under the guise of fixing the ACA, they do the thing they wanted to 
do all along--cut taxes, cut Medicaid. It has nothing to do with ACA: 
cut taxes, cut Medicaid. That is what the bill tomorrow will do. I 
don't care if it is the 2015 version. I don't care if it is BCRA. I 
don't care if it is a new Senate version. I don't care if it is Cruz's. 
All this cuts taxes for the wealthy and cuts Medicaid. That is what 
this legislation does.
  Americans are going to be hurt by this legislation; people with 
preexisting conditions, families with a loved one struggling with 
opioid abuse, people in nursing homes, people who rely on Medicaid, 
people who rely on Planned Parenthood. The tens of millions of people 
who will lose their insurance almost instantly. That is why every 
single patient advocacy group, from the American Cancer Society to the 
March of Dimes, to the National Physicians Alliance, to disability 
groups, to the AARP--everybody hates this bill. Make no mistake, they 
hate every version of it.
  It is not like there is a less harmful version. Either 22 million or 
23 million or 32 million lose their healthcare. We don't have to do 
this to ourselves. We don't have to do this to the American people.
  So there are lots of different versions of this legislation. What the 
leader is doing, very cleverly, is allowing people to believe that the 
thing they are moving to is the thing they may prefer. In other words, 
it is a blank canvas. It is just a motion to proceed. It is just a 
motion to begin debate.
  Make no mistake, the vote tomorrow is to repeal the Affordable Care 
Act with no plan to replace it. That is what they are doing tomorrow, 
and they have been totally secretive because they know the moment they 
start talking specifics, the whole thing comes crashing down.
  There are core elements of this vote tomorrow that are true no matter 
what. It cuts Medicaid; it cuts taxes for the rich; it reduces patient 
protections; it reduces the number of people who have insurance; and it 
will all be done with no hearings, no Democrats, no experts in 
healthcare. This thing will be dropped on us without enough time to 
review it, without enough time to interact with our home State to 
figure out what the impact would be.
  We are being asked to do one of the most reckless things any group of 
legislators has ever been asked to do, which is to jump off a policy 
cliff--a healthcare cliff, a political cliff--and eventually they are 
going to tell you it is going to work out. Make no mistake, the reason 
they can't tell you what is in the bill is the moment they do, this 
thing will come crashing down.
  What we have to do is make sure this thing comes crashing down 
anyway, and we have to do it for the tens of millions of Americans who 
depend on Medicaid and the ACA. We have to do it for our rural 
hospitals, we have to do it for people with preexisting conditions, and 
we have to do it for people without power, without money, without the 
ability to walk 200 yards from this Chamber to the U.S. Senate doctor, 
the best healthcare in the world.
  Not only are we on the exchange--I have a Kaiser plan so we are on 
the exchange, we are in ACA--but also, anytime I want, if I have a 
headache, if I have a stomach ache, if I have something more serious, I 
can literally walk about 200 yards from here, go to the Senate doctor, 
and get whatever kind of healthcare I need.
  I want you to understand how lucky the people who are voting on your 
future are and how privileged we all are in this literally gilded 
place, when people's lives and livelihoods and life savings are on the 
line tomorrow, and if I get so much as a hangnail, I get to call my 
staff and have them help me out. We are lucky people, and we need to 
think about whom we are representing. I will be fine. Every Member of 
this Chamber will be fine, but our job is not to take care of 
ourselves. Our job is to represent our constituents.
  This bill has earned a really historic title: Most unpopular major 
bill in American history. Most unpopular major bill in American 
history. How that can get 20 votes, let alone 51, is beyond me.
  I want to make one last point. We need to kill this bill, not just 
because of all the harm it is going to do to the country, we need to do 
it for the legislative branch of the U.S. Government. We just can't 
make laws like this.
  Right now, the majority party is shortsighted because at some point 
Democrats are going to have the gavel. The temptation to follow this 
precedent being set this week, to enact major legislation without 
hearings and without the other party, might destroy the Senate 
itself. There is still time. There is still good will. We can walk back 
from the brink and do the right thing.

  I yield the floor.
  The PRESIDING OFFICER (Mr. Sullivan). The Senator from Georgia.
  Mr. PERDUE. Mr. President, it is nice to see you here at 11 p.m. on 
Monday night. One of the privileges we have of being in the majority is 
that we get to preside over the U.S. Senate, so we can listen to all of 
our colleagues talk to this august body.
  I have been in that chair for the last couple of hours. I can't go to 
bed tonight without putting the record straight in this body. I don't 
think there is a Member of the U.S. Senate who doesn't want America to 
have the best healthcare in the world. The problem is, we have a 
campaign of disinformation that is underway right now, and it is 
outrageous. I cannot let it stand.
  My mission tonight, very briefly, will be to put some facts on the 
table, on the record, because we have a lot of innuendo right now, a 
lot disinformation: Oh, my God, people are going to die.
  Let me remind everybody, we are sitting here with a healthcare system 
that is collapsing. There is no other way to describe it.
  Why are we here tonight at 11 p.m.? Before I get to healthcare, I 
want to remind the American public of why the U.S. Senate is open 
tonight. We also did this earlier in the spring because something 
historic is underway right now in the United States of America and that 
is this: For the first time in our history, the minority party has not 
waived a Senate rule that would bypass the time requirements when 
confirming a nominee by the President of the United States. Because of 
that, we today have confirmed only around 29 percent of this 
President's nominees. The prior President, at this very point in time, 
had over 70 percent--over 70 percent--almost 300 people. I think the 
number today is under 50 for this President. It wasn't until a month or 
so ago that he could even have a full staff meeting.
  By the way, who is running America today? Holdovers from the last 
administration because we haven't been able to confirm the new 
nominees. Over 200 people right now stand in line, waiting to be 
confirmed by this body. It is outrageous.
  The American people ought to be upset. They ought to be more than 
upset. Let's define who is doing that. It is not the majority. The 
minority party is dragging their feet because it slows down everything 
else.
  Guess what doesn't get done this year if we continue with this 
schedule. Unless we are here every night, as we are tonight, we will 
not have time to get to taxes this year. We will not have time to get 
to what the American people are assuming we are going to get to. 
Consumer confidence is at a 13-year high

[[Page S4162]]

because they are anticipating that we are going to clean up some of 
this mess.
  Let me quickly move on to healthcare and put a few facts on the 
record tonight before we close. There are five healthcare systems in 
America. We forget this. We talk only about ObamaCare right now, but 
there are five healthcare systems in America.
  First, we have group policies. This is where almost the majority--the 
vast majority are in this. Anyone who works in a company or in a large 
organization has a group policy.
  Then there is the individual market. The individual market is what 
ObamaCare addresses. It is only 13 percent of the entire healthcare 
system.
  Then there is the VA.
  Then there are Medicare and Medicaid.
  There are five different systems of healthcare in the United States. 
What we are dealing with is the individual market and Medicaid--mostly 
the individual market.
  Let me try to describe the situation as we see it today. In 2008, 
before the ACA, there were 48 million people in America who did not 
have insurance. That is a catastrophe by anyone's measure. In the 
richest country in the history of the world, we had 48 million people 
who did not have insurance. You could be precluded from having 
insurance because of a preexisting condition. You could lose your 
insurance. You couldn't transfer across State lines. If you changed 
companies, even in group policies, you could be denied coverage under 
the next employer's policy.
  There were real problems. Both sides had responsibility for that, but 
today after the ACA, 28 million people, as we stand here tonight, still 
do not have insurance in America--28 million. Of the 20 million who got 
it, 16 got it only because of the expansion of Medicaid, not because of 
ObamaCare's work in the individual market; 16 million got it because of 
the expansion of Medicaid.
  All that was, was bribery from the Federal Government to certain 
States that decided to take the money and run. They didn't do their 
citizens a full justice. What we see of the remaining 4 million of the 
20 million who got insurance during ObamaCare--remember, 16 million got 
it because of the expansion of Medicaid; of the remaining 4 million, 2 
million are like my wife and me.
  Do you remember the day when President Obama said that if you like 
your insurance, you can keep your insurance and if you like your 
doctor, you can keep your doctor? Like most Democrats in the Senate and 
the House who voted on ObamaCare without reading it, he obviously 
didn't know what was in the bill because neither of those things were 
true.
  I was canceled. In an individual policy before I ran for the U.S. 
Senate, my individual policy as a retiree was canceled, and the only 
policy we could get under the exchange in ObamaCare included things 
like vision, hearing, drug rehabilitation. I have never had a problem 
with that. My wife hasn't either.
  By the way, maternity--I met my wife in first grade. We are not 
having babies at this age. What is that? My rate is almost double 
because we had to take things in policies that we did not need.
  Of the remaining 2 million, 1 million are the most destitute, low-
income people who really do need our help, but we have disrupted the 
entire healthcare system because the Democrats thought that the bigger 
government approach would work.
  How has that worked out in places like the VA? I hear talk now about 
single payer; I will get to that in a second. If you like the VA, you 
are going to love a single-payer system because that is exactly what it 
is.
  Let me go on. I have heard a lot of talk in this Chamber tonight 
about, oh my God, the Republicans are going to hurt people in America--
hurt people in America.
  Let me talk about who is hurting people in America today. This is a 
travesty in itself. We cannot get the information from the IRS. We have 
just now gotten the information from the IRS. In 2014, the IRS, under 
the rules of ObamaCare, fined 8 million people $1.8 billion.
  Mr. President, I don't know about you, but I am outraged. I know you 
are too.
  The irony of that is that 85 percent of the people who were fined in 
2014--$1.8 billion--85 percent made less than $50,000, and less than 
half of them made $25,000.
  What our Democratic friends did was cram down the throats of 
Americans this thing called ObamaCare, and then they put fines on 
people who couldn't afford insurance, and they are the poorest people 
in our country.
  Who is standing for those guys today--the Democrats? Don't you bet. 
They want a Big Government solution that gives them more power, and 
they could not care less about the very poor people they claim to 
champion. I have had enough of it. This is outrageous.
  Twenty-two million people are going to lose insurance. That is what 
they tell us. Let's clean this up right now. The CBO's own estimate 
says that once you remove the mandate--forget about what else is 
available. If you just remove the mandate, because the policies are so 
expensive, 15 million are going to give it up. That is happening today.
  By the way, do you know that CBO is using a March 2016 baseline to 
compare these numbers to? It is outrageous. In business, you would 
never accept this. Yet today they are determined to be the ``holy 
grail'' up here. I haven't seen a number come out of the CBO that I 
would depend on yet. In fact, in 2010, they overestimated the number of 
people who would sign up for ObamaCare by 12 million people. They 
missed the estimate by more than 50 percent. This isn't a rounding 
error. They don't know what they are doing.
  Right now, today, we have the same problem. Fifteen million people 
say they will give up their insurance voluntarily because it is too 
expensive. That has nothing to do with the new plan. That is because 
ObamaCare is too expensive.
  They also say that 4 million people will give up Medicaid. Medicaid 
is free. Why would somebody give up Medicaid?
  They say ObamaCare is so good and so affordable that they are going 
to add 5 million people to it. There is no evidence today that would 
back that claim up. That is not a quantified model outcome. It is the 
estimate of a person who sits over there and makes this up. The other 
side is acting like, oh my goodness, this is the ``holy grail.''
  Let's talk about this. The premiums under ObamaCare prior to this 
year, over the last 2 years, are up over 105 percent in America. They 
say that the reason premiums are going up is because of uncertainty 
coming out of the White House. This year's rates were determined last 
year, before we even knew this President was going to be a nominee. 
That is more disinformation.
  What I am fed up with is that it sounds like a good story until you 
see the facts. The premiums in my State alone going into next year are 
going up 42 percent.
  Here is the untold truth: In my State, 96 of 159 counties have only 
one carrier. That is a monopoly. They can do pretty much whatever they 
want. That is under ObamaCare, not anything else we are talking about. 
That is the reality today.
  By the way, here is the real comeuppance. Today in my State--and you 
have the same problem in your State--300,000 people who make less than 
the poverty rate in my State cannot get insurance today under 
ObamaCare. Forget about what we are talking about to fix this mess. 
Today under ObamaCare, they can't get insurance--300,000 people in my 
State. That is true in every State in our country. That is the untold 
ugliness of ObamaCare.
  ObamaCare is hurting people right now. I am tired of hearing the 
other side talk about how they care for people--they care for people--
and then they fine the poorest people in America $1.8 billion. Then 
they deny 300,000 people in my State access to healthcare. Enough 
already.
  What are we doing about it? Six months ago, this President said that 
there were four objectives that any healthcare system in America and 
the individual market had to meet. The first was access. We have 
already talked about how ObamaCare is failing people who need access to 
it. The lowest income people in America are being denied insurance 
under ObamaCare. We fixed that. People who want insurance are going to 
get insurance.
  By the way, premiums were the second thing we had to do to try to get 
costs down because it is becoming too

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prohibitive. I have sons in the middle of their careers. They can't 
really afford the insurance they are being offered today. I feel it 
firsthand in my own life.
  Premiums right now, though--if we put into place the suggestions we 
have on the table right now, the HHS Department has estimated just last 
week with a very credible model that rates could come down as much as 
78 percent in the next 4 years. Has anybody heard the other side remind 
us of that data point? No. Why do those rates come down? Because the 
free-market system gets to act again, instead of being shackled in 
choices being removed. All of a sudden, now we move into it.
  By the way, they talk about these made-up fantasy policies. Wait a 
minute. I had one of those made-up fantasy policies that you can't get 
today under ObamaCare. It is called catastrophic coverage. For some 
people with a high deductible, catastrophic coverage--that works. They 
are denied that today because Big Government knows more about what you 
need in your personal life.
  The third thing we had to do--and this was very important. The second 
part of this problem is that Medicaid was not on a sustainable path. I 
am sorry. They have overpromised, and they cannot deliver. There is no 
way over the next 30 years that we can sustain Medicaid. Just as 
Medicare and Social Security are going bankrupt, we cannot afford to do 
what they are promising people we are going to do. They know that. They 
already know that.
  Just like the Great Society, these Big Government programs that they 
promise all the time are going to work have never worked. The Great 
Society, the War on Poverty was going to remove poverty from America. I 
remember that.
  I sit at a desk where that bill was signed by the then-Democratic 
leader of the Senate, Richard Russell, before it went to the White 
House. I am reminded every day of how Big Government has failed the 
American people. That war on poverty has spent trillions of dollars 
trying to reduce poverty in America. Yet, today, the poverty rate is 
fundamentally the same as it was in 1965 when that was signed into law.
  Big Government does not work in situations like this. I lived under a 
single payer. My son lived under a single payer. This is the 
alternative they are after. I have heard it mentioned three times on 
the floor of the Senate tonight. We cannot go there. It bifurcates 
delivery. It would add $3.2 trillion. That is more than we spend on all 
of our mandatory expenses today--$3.2 trillion every single year. That 
is impossible. If you think that would work, imagine this. Go home and 
look at your tax bill. Whatever you paid the Federal Government last 
year, double it. That is what that would mean. It is not workable.

  The fourth thing we had to do was make sure preexisting conditions 
were protected. I worried about that through my entire career. If I 
changed jobs, if I had been sick or my family had been sick, I might 
have been denied insurance. We can't allow that. This bill doesn't 
allow that. We protected preexisting conditions. We put Medicaid on a 
sustainable path for the long term. We also bring premiums down. That 
was a major priority here. And we give everybody in America access to 
healthcare--period, end of the conversation.
  That is not good enough. The other side is not going to be happy 
until this Federal Government steps in and takes over 18 percent of our 
economy called healthcare. They tried to do it in 1992 to 1994, under 
HillaryCare. They tried to do it here. I remember the Speaker of the 
House saying: If you want to know what is in this bill, you have to 
vote for the bill. We are not doing that today. This cloud of innuendo 
that the other side has perpetrated on the American people is just not 
true.
  In 2010, not one Republican voted for ObamaCare. Not one amendment 
got to the floor of this Senate. Yet they want to talk about this great 
open policy. They had 7 years to fix this mess. People in my State have 
been hurt by it. It is unforgivable, and we can do something about it 
this week.
  Senator John McCain is very sick. He is a fighter. He will take care 
of this. I hope he will be back this week to help us. If he can, I 
think he will. We are going to vote on it this week. We have to do this 
for the American people.
  I want to remind everybody what is at stake here. If we don't pass 
this tomorrow, then we end up moving toward a single-payer system. Let 
me remind everybody of the other Big Government failures we talk about: 
the VA and the Postal Service. Fannie Mae and Freddie Mac are bankrupt. 
We talk about the ObamaCare failures. Then there is the Great Society 
of rural poverty. I want to remind everybody.
  Let me close with this. I heard tonight that this is a reckless 
action, the new policy. I heard New Testament examples about how to 
take care of your brethren. It is shocking to me that somebody on the 
other side would say that when they know these statistics of what they 
have done--8 million of the poorest people in America have been fined 
$1.8 billion. Half of them make under $25,000 a year. That is taking 
care of your brethren all right. I am embarrassed. We can fix that.
  I believe we heard the rain of devastation: No one is helped by this 
bill; it is a reckless act. Here is the one I love: We want to work 
with you. We want to work with you to help fix this thing. Just a year 
ago, I didn't hear any speeches in here--I don't think you did from 
that Chair--where anybody on that side acknowledged that there was 
anything wrong with ObamaCare. You hear today: We want to work with you 
to help fix ObamaCare. It is 7 years too late, in my opinion. It would 
have been nice to have been included in the conversation in 2009 and 
2010 when it was crammed down the throats of Republicans.
  I believe this is a historic moment in America, not just for 
healthcare. Healthcare is very important, but it is bigger than that. 
This is about the direction of our country. Are we going to try to 
trust Big Government again and again until we can't afford it? We are 
already well down that rabbit hole. We cannot afford this chance again. 
We have already proven it doesn't work.
  I hope that this week colleagues on our side will get together and we 
will vote this thing in. I welcome any Democratic support as well. I 
know we are not going to get it. This is a time to stand. I hope we 
will have that vote. I fully encourage my colleagues here to support 
that. Let's get on with business.

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