[Congressional Record Volume 163, Number 125 (Tuesday, July 25, 2017)]
[Extensions of Remarks]
[Pages E1049-E1052]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                       SENATE VOTE ON ACA REPEAL

                                 ______
                                 

                        HON. SHEILA JACKSON LEE

                                of texas

                    in the house of representatives

                         Tuesday, July 25, 2017

  Ms. JACKSON LEE. Mr. Speaker, today, in a move that is a betrayal to 
the American people, the Senate voted 51 to 50 on a motion to advance 
debate on a piece of Republican legislation that would do away with 
most of the Affordable Care Act.
  Reaching a 51-50 vote, where the tie was broken by Vice President 
Mike Pence, has been a struggle for Republican Members of the Senate 
because they realize that a repeal of Obamacare would result in tragedy 
for millions of Americans.

[[Page E1050]]

  I want you to know that I oppose this and previous versions of 
Obamacare repeal for several compelling reasons:
  1. Trumpcare forces families to pay higher premiums and deductibles, 
increasing out-of-pocket costs.
  2. Trumpcare will take away health care from 24 million hardworking 
Americans.
  3. Trumpcare would gut essential health benefits and protections for 
Americans with pre-existing conditions.
  4. Trumpcare forces Americans aged 50-64 to pay premiums five times 
higher than what others pay for health coverage, no matter how healthy 
they are.
  5. Trumpcare shortens the life of the Medicare Trust Fund and 
ransacks funds that seniors depend on to get the long-term care they 
need.
  Eighty-five months ago, on March 23, 2010, President Barack Obama 
redeemed a promise that had been unfulfilled for nearly a 100 years, 
when he signed into law the landmark Affordable Care Act passed by the 
Democratic controlled 111th Congress.
  Seven years later, the verdict is in on the Affordable Care Act: the 
American people have judged it a success.
  As reflected in the most recent public opinion polls, 61% of 
Americans approve of Obamacare and oppose efforts to repeal it, the 
highest approval rates on record to date and continuing an inexorable 
upward trend over the past several years.
  The reason Americans are adamantly opposed to Republican repeal 
efforts, including the third iteration of Trumpcare now before us, is 
that Obamacare is no longer a bogey cooked up in Republican talking 
points but a life-saving and life affirming measure that they have 
experienced in their own lives.
  Americans think it is beyond crazy to repeal a law that has brought 
to more than 20 million Americans the peace of mind and security that 
comes with knowing they have access to affordable, high quality health 
care.
  Mr. Speaker, before the passage of the Affordable Care Act, 17.1 
percent of Americans lacked health insurance; today nearly nine of ten 
(89.1 percent) are insured, which is the highest rate since Gallup 
began tracking insurance coverage in 2008.
  Because of the Affordable Healthcare Act:
  1. Insurance companies are banned from discriminating against anyone, 
including 17 million children, with a preexisting condition, or 
charging higher rates based on gender or health status;
  2. 6.6 million young adults up to age 26 can stay on their parents' 
health insurance plans;
  3. 100 million Americans no longer have annual or lifetime limits on 
healthcare coverage;
  4. 6.3 million seniors in the ``donut hole'' have saved $6.1 billion 
on their prescription drugs;
  5. 3.2 million seniors now get free annual wellness visits under 
Medicare, and
  6. 360,000 small businesses are using the Health Care Tax Credit to 
help them provide health insurance to their workers;
  7. Pregnancy is no longer a pre-existing condition and women can no 
longer be charged a higher rate just because they are women.
  We are becoming a nation of equals when it comes to access to 
affordable healthcare insurance.
  Mr. Speaker, with all of this progress, and the prospect for more 
through further refinements, who in their right mind would want to go 
back to how it used to be?
  The answer seems to be only the President and House Republicans who 
call the Affordable Care Act and its enviable record of success a 
``disaster.''
  Americans know a disaster when they see one and they see one in the 
making: it is called ``Trumpcare,'' masquerading as the ``American 
Health Care Act,'' which will force Americans to pay more, get less, 
decimate the Medicare and Medicaid programs, and give a massive tax cut 
for top 1 percent.
  Americans are right to be alarmed and angered by what the Trump 
Republicans are trying to do by rushing to vote on a Trumpcare bill 
before it can be scored by highly respected and nonpartisan 
Congressional Budget Office.
  What we do know for sure is that this Trumpcare bill is a massive 
$900 billion tax cut for the wealthy, paid for on the backs of 
America's seniors, the vulnerable, the poor, and working class 
households.
  Trump gave the game away on March 20, 2017 in one of his trademark 
pep rallies:
  ``We want a very big tax cut, but cannot do that until we keep our 
promise to repeal and replace the disaster known as Obamacare.''
  This ``Robin Hood in reverse'' bill is unprecedented and breathtaking 
in its audacity--no bill ever tried to give so much to the rich while 
taking so much from the poor and working class.
  When they were forced to pull Trumpcare 1.0 from the floor because 
they lacked the votes to pass, House Republican leaders responded by 
adding an amendment (Trumpcare 2.0) that made the original bill even 
worse.
  Trumpcare 2.0 would allow states to jettison existing essential 
health benefit requirements, thereby permitting health plans covering 
millions of people once again to exclude coverage for maternity and 
newborn care, pediatric dental and vision services, mental health and 
substance use services, and other crucial benefits.
  All this accomplished was a hemorrhaging of support from the moderate 
wing of the Republican Conference who feared the repercussions of 
leaving millions of Americans with preexisting conditions without 
health insurance so the Trump Republicans invented Trumpcare 3.0 to 
provide $8 billion over five years to offset the cost of setting up 
separate pools or premium assistance programs for people with pre-
existing conditions.
  Mr. Speaker, this pittance is not designed or intended to help real 
people with real preexisting conditions, but to provide the cover for 
House Republicans to walk the plank.
  According to the Kaiser Family Foundation, at least $25 billion per 
year would be required, not $8 billion spread out over five years as 
provided for in Trumpcare 3.0.
  Trumpcare represents the largest transfer of wealth from the bottom 
99 percent to the top 1 percent in American history.
  This callous Republican scheme gives gigantic tax cuts to the rich, 
and pays for it by taking insurance away from 24 million people, 
leaving 52 million uninsured, and raising costs for the poor and middle 
class.
  In addition, Republicans are giving the pharmaceutical industry a big 
tax repeal, worth nearly $25 billion over a decade without demanding in 
return any reduction in the cost of prescription and brand-name drugs.
  To paraphrase Winston Churchill, of this bill, it can truly be said 
that ``never has so much been taken from so many to benefit so few.''
  The Pay-More-For-Less plan destroys the Medicaid program under the 
cover of repealing the Affordable Care Act Medicaid expansion.
  CBO estimates 14 million Americans will lose Medicaid coverage by 
2026 under the Republican plan.
  In addition to terminating the ACA Medicaid expansion, the bill 
converts Medicaid to a per-capita cap that is not guaranteed to keep 
pace with health costs starting in 2020.
  The combined effect of these policies is to slash $880 billion in 
federal Medicaid funding over the next decade.
  The cuts get deeper with each passing year, reaching 25 percent of 
Medicaid spending in 2026.
  These steep cuts will force states to drop people from Medicaid 
entirely or ration care for those who most need access to comprehensive 
coverage.
  The Pay-More-For-Less plan undermines the health care safety net for 
vulnerable populations.
  Currently, Medicaid provides coverage to more than 70 million 
Americans, including children, pregnant women, seniors in Medicare, 
people who are too disabled to work, and parents struggling to get by 
on poverty-level wages.
  In addition to doctor and hospital visits, Medicaid covers long-term 
services like nursing homes and home and community-based services that 
allow people with chronic health conditions and disabilities to live 
independently.
  To date, 31 states and D.C. have expanded Medicaid eligibility to 
low-income adults, which, when combined with the ACA's other coverage 
provisions, has helped to reduce the nation's uninsured rate to the 
lowest in history.
  Trumpcare throws 24 million Americans off their health insurance by 
2026 according to the Congressional Budget Office.
  Mr. Speaker, low-income people will be hit especially hard because 14 
million people will lose access to Medicaid by 2026 according to CBO.
  Trumpcare massively shifts who gets insured in the nongroup market.
  According to CBO, ``fewer lower-income people would obtain coverage 
through the nongroup market under the legislation than current law,'' 
and, ``a larger share of enrollees in the nongroup market would be 
younger people and a smaller share would be older people.''
  The projected 10 percent reduction in premiums is not the result of 
better care or efficiency--it is in large part the result of higher-
cost and older people being pushed out of a market that is also selling 
plans that provide less financial protection.
  People with low incomes suffer the greatest losses in coverage.
  CBO projects the uninsured rate for people in their 30s and 40s with 
incomes below 200 percent of poverty will reach 38 percent in 2026 
under this bill, nearly twice the rate projected under current law.
  Among people aged 50-64, CBO projects 30 percent of those with 
incomes below 200 percent of poverty will be uninsured in 2026.
  Under current law, CBO projects the uninsured rate would only be 12 
percent.

[[Page E1051]]

  Being uninsured is not about ``freedom.''
  Speaker Ryan has argued that people will happily forgo insurance 
coverage because this bill gives them that ``freedom.''
  The argument makes as much sense as the foolish claim that slaves 
came to America as ``immigrants'' seeking a better life.
  The freedom to be uninsured is no freedom at all to people in their 
50s and 60s with modest incomes who simply cannot afford to pay 
thousands of dollars toward premiums.
  They do not really have a choice.
  The claim of our Republican friends that Trumpcare provides more 
freedom to all Americans calls to mind the words of Anatole France:
  ``The law, in its majestic equality, forbids the rich as well as the 
poor to sleep under bridges, to beg in the streets, and to steal bread 
from the market.''
  Trumpcare raises costs for Americans nearing retirement, essentially 
imposing an ``Age Tax.''
   The bill allows insurance companies to charge older enrollees higher 
premiums than allowed under current law, while reducing the size of 
premium tax credits provided.
   Again, these changes hit low-income older persons the hardest.
  A 64-year-old with an income of $26,500 buying coverage in the 
individual market will pay $12,900 more toward their premiums in 2026, 
on average.
  Trumpcare raises costs for individuals and families with modest 
incomes, particularly older Americans.
  Mr. Speaker, a recent analysis found that in 2020, individuals with 
incomes of about $31,000 would pay on average $4,000 more out of pocket 
for health care--which is like getting a 13 percent pay cut.
  And the older you are, the worse it gets.
   An analysis by the Urban Institute estimates that for Americans in 
their 50s and 60s, the tax credits alone would only be sufficient to 
buy plans with major holes in them, such as a $30,000 deductible for 
family coverage and no coverage at all of brand-name drugs or many 
therapy services.
   Another reason I oppose the Trumpcare bill before us is because its 
draconian cuts in Medicaid funding and phase-out of Medicaid expansion 
put community health centers at risk.
  Community health centers are consumer-driven and patient-centered 
organizations that serve as a comprehensive and cost effective primary 
health care option for America's most underserved communities.
   Community health centers serve as the health care home for more than 
25 million patients in nearly 10,000 communities across the country.
  Across the country, 550 new clinics have opened to receive 5 million 
new patients since 2009.
  Community health centers serve everyone regardless of ability to pay 
or insurance status:
  1. 71 percent of health center patients have incomes at or below 100 
percent of poverty and 92 percent have incomes less than 200 percent of 
poverty;
  2. 49 percent of health center patients are on Medicaid; and
  3. 24 percent are uninsured;
  4. Community health centers annually serve on average 1.2 million 
homeless patients and more than 300,000 veterans.
   Community health centers reduce health care costs and produce 
savings--on average, health centers save 24 percent per Medicaid 
patient when compared to other providers.
  Community health centers integrate critical medical and social 
services such as oral health, mental health, substance abuse, case 
management, and translation, under one roof.
  Community health centers employ nearly 190,000 people and generate 
over $45 billion in total economic activity in some of the nation's 
most distressed communities.
  Community health centers are on the front lines of every major health 
crisis our country faces, from providing access to care (and 
employment) to veterans to addressing the opioid epidemic to responding 
to public health threats like the Zika virus.
   We should be providing more support and funding to community health 
centers, not making it more difficult for them to serve the communities 
that desperately need them by slashing Medicaid funding.
  The Trumpcare Republican plan leaves rural Americans worse off.
  Health insurance has historically been more expensive in rural areas 
because services cost more and it is hard to have a stable individual 
market with a small population.
  Mr. Speaker, under the Affordable Care Act, premium subsidies are 
tied to local costs, which helps keep premium costs down.
  But they are not under the Republican plan.
  So, under the Republican plan residents in rural areas, who tend to 
be older and poorer, will pay much more and get much less health 
insurance.
  At the end of the day, the powerful and compelling reasons to reject 
Trumpcare lie in the real world experiences of the American people.
  Mr. Speaker, let me briefly share with you the positive, life 
affirming difference made by the Affordable Care Act in the lives of 
just three of the millions of Americans it has helped.


                              joan fanwick

  ``If Obamacare is repealed, I don't know if I'll live to see the next 
President.
  ``After nearly a decade of mysterious health scares, I was diagnosed 
with an autoimmune disorder called Sjogren's syndrome last year, when I 
was a junior at Temple University.
  ``It's a chronic illness with no known cause or cure, and without 
close medical surveillance and care, it can lead to life-threatening 
complications (like the blood infections I frequently experience).
  ``For me, having this disorder means waking up every morning and 
taking 10 different medications.
  ``It also means a nurse visiting my apartment every Saturday to 
insert a needle into the port in my chest, so I can give myself IV 
fluids throughout the week.
  ``Without insurance, my medical expenses would cost me about $1,000 
per week--more than $50,000 per year. And that doesn't even include 
hospitalizations.
  ``My medical bills aren't cheap under Obamacare, but I can afford 
them.
  ``Under Obamacare, insurance companies aren't allowed to cut you off 
when your costs climb so right now, the most I personally have to pay 
out of pocket is $1,000 per year.''


                             brian norgaard

  ``I am a small business owner and leadership trainer who Obamacare 
has helped tremendously.''
  Brian Norgaard, a Dallas, Texas resident, called my office to express 
his opposition to Trumpcare and to share how the Affordable Care Act 
has helped small business owners like himself:
  ``I am a small business owner and leadership trainer who Obamacare 
has helped tremendously.
  ``My wife and I both own small businesses in the Dallas, Texas area 
and as a result of the huge savings we received after paying lower 
healthcare premiums under Obamacare, we were able to reinvest those 
savings into both of our businesses and the community.
  ``And the healthcare we received was quality, at that.''


                             ASHLEY WALTON

  ``For cancer survivors, we literally live and die by insurance.''
  Ashley Walton was 25 when a mole on her back turned out to be 
melanoma.
  She had it removed, but three years later she discovered a lump in 
her abdomen.
  She was then unemployed and uninsured, and so she put off going to a 
doctor.
  She tried to buy health insurance. Every company rejected her.
  Ashley eventually became eligible for California's Medicaid program, 
which had been expanded under the Affordable Care Act.
  The 32-year-old Oakland resident credits her survival to the ACA.
  Without it, ``I would likely be dead, and my family would likely be 
bankrupt from trying to save me.''
  Before any of our Republican colleagues supporting this bill cast 
their vote, I urge them to reflect on the testimony of Joan, Brian, and 
Ashley, and on this question posed by a constituent to Sen. Cotton of 
Arkansas at a recent town hall:
  ``I've got a husband dying and we can't afford--let me tell you 
something.
  ``If you can get us better coverage than this Obamacare, go for it.
  ``Let me tell you what we have, plus a lot of benefits that we need.
  ``We have $29 per month for my husband. Can you beat that? Can you?
  ``With all the congestive heart failures, and open heart surgeries, 
we're trying. $29 per month. And he's a hard worker. $39 for me.''
  Like a horror film of yore with monsters and vampires, both the 
original Trumpcare and its sequels threaten to return this country to 
the days when annual and lifetime dollar-based limits on the use of 
essential health benefits shifted tremendous financial and health risks 
to working families.
  Insurance companies could charge people with pre-existing conditions 
many times more than they charge healthy people--just as they did 
before the Affordable Care Act.
  Millions of Americans with pre-existing conditions would be at risk 
of losing health coverage or face premiums so high only the very 
wealthy could afford them--the same people who benefit from the massive 
tax cuts in the original bill.
  That is why we cannot rest until Trumpcare, one of the most 
monstrously cruel and morally bankrupt legislative proposals, is dead 
and buried.
  To paraphrase a famous former reality television personality, 
``believe me, Trumpcare is a disaster.''
   We should reject it and keep instead ``something terrific'' and that 
is the Affordable Care

[[Page E1052]]

Act, regarded lovingly by millions of Americans as ``Obamacare.''
  I commend my colleague, Congressman Garamendi, for holding this 
Special Order to denounce Trumpcare.
  I urge our colleagues in the Senate to listen to their constituents 
and do what is right: vote no to repeal Obamacare.