[Congressional Record Volume 163, Number 125 (Tuesday, July 25, 2017)]
[House]
[Pages H6286-H6292]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                               HEALTHCARE

  The SPEAKER pro tempore (Mr. Fitzpatrick). Under the Speaker's 
announced policy of January 3, 2017, the gentleman from California (Mr. 
Garamendi) is recognized for 60 minutes as the designee of the minority 
leader.

[[Page H6287]]

  

  Mr. GARAMENDI. Mr. Speaker, I want to follow along on my Republican 
colleagues, as they were talking about rural America.
  As a son of rural America, I agree with much of what they said about 
the role of the Federal Government in providing support in so many 
different ways to rural America. Many of the programs that they were 
talking about are really found in the effort of the U.S. Government to 
rebuild rural America following or during the days of the Great 
Depression.
  Mr. Speaker, I want to put up here on my easel one of the key 
documents. This is actually etched in the marble at the Franklin Delano 
Roosevelt Memorial here in Washington, D.C. I think it is instructive 
as we talk about rural America and what is going on in rural America 
today, and really across all of America.
  During the height of the Depression, Franklin Delano Roosevelt said 
these words:
  ``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 too little.''
  During those days of the Depression, rural America was hurting, it 
was devastated, and many of the programs that we just heard about from 
our Republican colleagues were put in place at that time.
  In 2010, the Congress of the United States, together with President 
Obama, put in place another program that significantly helped rural 
America. Today--in fact, just a couple of hours ago--the United States 
Senate moved to remove from rural America the pillar of healthcare that 
has provided millions of those 46 million Americans in rural America 
with healthcare.

                              {time}  1830

  Through the expansion of the Medicaid program, the Medi-Cal program 
in California, many of my constituents in rural America were able to 
get healthcare for the first time, and they were also able to get 
insurance because of the cost share reduction program where their 
insurance premiums on the exchanges were reduced to a level that they 
could afford.
  A significant program for rural America is now in jeopardy as a 
result of the Congress of the United States passing legislation a 
couple of months ago that would repeal the Affordable Care Act and 
replace it with whole cloth, ripping apart the Medicaid Expansion 
program so that across this Nation some 16 million Americans would lose 
their Medicaid coverage immediately, and more beyond that.
  So in the initial year, 2018, 10 million Americans, many of them in 
rural America, would lose their health coverage. Across this Nation in 
the out-years, by 2025, 24 million Americans would lose their health 
coverage as a result of the actions of the Republicans here in 
Congress.
  Today, just a couple of hours ago, the Senate decided to move forward 
to make it even worse, to repeal and maybe not even replace, so that 32 
million people would lose their coverage if that were to happen. 
Eighteen million in 2018 and 2019 would lose their health coverage 
under the program that was proposed by the U.S. Senate last week.
  Unbelievable that, here on the floor, we heard a discussion about 
rural America and the needs of rural America.
  I am here to tell you, as the son of rural America, I grew up on a 
ranch 2 miles from a community that had 500 people in it, that had a 
three-room schoolhouse and just five of us in the eighth grade class. I 
have raised my children in a community twice as large, a thousand 
people in rural America, and I know that the people in my community 
today depend upon the Affordable Care Act, ObamaCare, for the 
healthcare coverage that they now have.
  In California, over 5 million Californians gained coverage. The 
uninsured rate dropped by 50 percent, from 18 to just over 9 percent.
  Why? Why on Earth would we neglect this, these statements, this moral 
imperative set down by Franklin Delano Roosevelt. It is not what we are 
going to do for the wealthy.
  And keep this in mind, that the legislation that passed this House 
and repeated over in the Senate would be the largest transfer of wealth 
of any legislation ever--ever--by the Congress of the United States, 
transferring more than a trillion dollars from the men and women who 
have been able to gain coverage in their healthcare.
  This is real money taken out of their pockets as these programs 
disappear because of the repeal and the replacement: a trillion dollars 
taken from the working men and women and the poor in America and 
transferred to the wealthy. That is what the legislation did that 
passed this House; that is what is being considered in the Senate at 
this moment: a monumental transfer of wealth, the largest transfer of 
wealth in any single piece of legislation.
  How can it be, if this is the test, not what we are doing for the 
wealthy, not for those who have much, but, rather, for those in rural 
America and urban America who have so little?
  America ought to be upset. America ought to be outraged at what is 
happening today.
  We need to build America. We need a better America. We need better 
jobs. We need better wages. We need better healthcare, better 
education.
  That is what we need, but where is this Congress going? It is going 
in exactly the opposite direction. It is taking money out of the 
pockets of Americans, rural and urban and everybody in between, 
transferring a trillion dollars from their pockets to the superwealthy.
  Who are they? Five members, including the President, in the Cabinet 
of the United States are among the superwealthy, the 400 wealthiest 
families in America. They are there in the Cabinet, in the President's 
office.
  What do they stand to gain? A $4 million, $5 million, $6 million, $7 
million reduction in their taxes.
  What do the working men and women of America stand to gain? Their 
healthcare is going to be taken away from them, not just in the 
reduction of the cost sharing, but also in the fact that, as we know it 
today, the insurance market itself will be so destabilized, so 
destabilized by the proposed action of the Senate and the House, that 
it will really enter a death spiral, because the proposed laws allow 
the healthy to opt out, and those who need insurance would continue to 
try to get their insurance in an ever-increasing market of people who 
have high health expenses. That is called a death spiral.
  I know this. I was the insurance commissioner in California for 8 
years, and we fought all those 8 years, from 1991 until I left that 
office in 2006, we fought to try to put in place laws that are now in 
place as a result of ObamaCare. The insurance companies cannot 
discriminate on the basis of preexisting conditions. The fact that you 
are a woman, the fact that you are older, they cannot discriminate. But 
the bill that is now being debated in the Senate and will be back here 
in the House allows for a return to those days of discrimination.
  So if you happen to need healthcare, if you happen to have a 
preexisting condition, if you happen to have high blood pressure, 
diabetes, or you happen to be 60 years or 50 years of age, you will be 
hit with a heavy increase in your premiums, perhaps two- to threefold 
increases. That is what they are promising Americans.
  We can't let it happen. And interestingly enough, America is pushing 
back. They say: No more. No more. What we want is better healthcare. We 
don't want to lose our healthcare policy. What we want is better 
education. We want you in Congress to work on the education systems, on 
the skills that my children need, your children need to be able to get 
a decent job.
  Americans want higher wages. They don't want their healthcare ripped 
away as is happening here. They want us to focus on infrastructure. 
They want us to focus on the well-paying jobs that occur from 
infrastructure. Better jobs, better wages, better healthcare, better 
education--that is where we are going.

  And by God, we are going to protect the Affordable Care Act and we 
are going to stand with Americans. We are going to stand with Americans 
all across this Nation that say: No, we are not going to let it happen.
  Mr. Trump, I know that you promised a repeal, but you are wrong, Mr. 
President, you are wrong.
  Mr. Speaker, I pass that message on to the President. You should not 
take away from working men and women

[[Page H6288]]

who, for the first time, are able to get their healthcare and are able 
to afford the private sector market or are able to get on the Medicaid 
programs. You should not take it away so that you can give, to the 
superwealthy, a trillion dollars. It is outrageous.
  I need to take a deep breath. I am a bit riled up. I am a bit riled 
up when I hear my colleagues come in and talk about rural America, 
where I know, from my experience in my district, there is an opioid 
epidemic and methamphetamines, and I know that those people are 
dependent upon the Medicaid program that they intend to rip away.
  Okay. Calm down, John. Don't get too excited. Don't get too mad. Take 
a deep breath and turn it over to my colleague from the East Coast.
  Congressman Tonko, you and I have been on this floor many times 
talking about making it in America, about jobs, about making it better 
for education. Give me a chance to take a deep breath.
  Mr. TONKO. Mr. Speaker, I thank the gentleman from California for 
yielding.
  Certainly I understand the anger, Representative Garamendi, and I 
know I am not alone. I know all of my colleagues are hearing the 
outbursts in our given districts about the foolishness and the hard-
heartedness of taking away a very valuable asset. Healthcare coverage 
is so important now to the American public, but in a particular way, it 
is near and dear to those who most recently realized that coverage.
  I will tell you, being on this floor when the Affordable Care Act was 
passed, that was a monumental effort. It was difficult to launch that 
program. It took a lot of hard work, years of messaging, going to 
hearings, working those amendments that were suggested into the 
discussion, and making certain that the package met the mission that we 
embarked upon. So it is important now to make certain that we only go 
forward and upward from this moment.
  Like many programs before the Affordable Care Act--Social Security, 
Medicare, Medicaid--they were difficult to launch; but unlike those 
programs, Congress and the Presidents in those given eras came forward 
and said: Okay. What did we learn from that launch? How can we improve 
upon the package? How can we strengthen some of the dynamics of 
concern?
  Here we have people, as you indicated, that are not only unwilling to 
make those reforms possible, but disguising what they call healthcare 
reform in the name of a tax package for the wealthy. How vulgar is 
that, when you can sweep the dollars, the savings from denying people 
healthcare coverage, and utilize it to relieve taxes for those most 
comfortable in our society? For those 400 households of which you 
spoke, the on-average relief was on the order of $7 million. Imagine 
that: taking away healthcare from people who live paycheck to paycheck 
in some cases, and using that to provide for tax relief for those most 
comfortable.
  That is not in keeping with the spirit of this legislation. It is not 
in keeping with the harmony that was necessary to create this 
legislation.
  The spirit was to speak to the fundamental needs of healthcare for 
individuals and families across this country to be able to get past 
difficult moments and situations like preexisting conditions, 
preexisting conditions that can be with an individual toddler from the 
moment of birth, as we have heard in the news.
  This hard-hearted approach, this senseless attitude, this insensitive 
expression to Americans across this country by these reform efforts, 
today we know that the United States Senate went forth with a vote to 
proceed on their efforts. What will it be? Straightforward repeal, as 
the President recommends, where 30-plus million people lose their 
healthcare coverage, you rip it away from those tens of millions? Or 
will it be repeal and delay? Or will it be repeal and replace?
  So far with the iterations, the versions of healthcare reform that 
have come forth from this House, that were approved in this House and 
sent over to the Senate, those devised by the Senate have been 
heartless.
  This is about expressing compassion, about being just and fair.
  Just this weekend I was with groups of constituents. The first that 
comes to mind is a fundraising effort for individuals who live with 
cystic fibrosis. Before I was even to walk into the room, where 
hundreds of people gathered to support the efforts for this cause, 
individual sets of parents came to me and said: Keep up the fight to 
keep Medicaid in the equation.

                              {time}  1845

  Our daughter, our son, can't do it without Medicaid. And these people 
were proud of their given children, adult children, in some cases, who 
had graduated with honors, played athletics and were athletes, star 
athletes in their high school years who, then, earned full scholarships 
to college. And his daughter made him most proud; he cited that moment 
of pride when he witnessed her on her campus wheeling her IV to class.
  That is what we see out there, motivation, inspiration, respect for 
people who live with difficult challenges in life. And we were 
responding as a compassionate society, one that should separate us from 
the rest of the world because, within our abundance, we want to share 
that with everybody.
  And it is so wonderful, Representative Garamendi, that you would 
bring that quote from the memorial, that speaks to the abundance of 
those who have where we are, evidently, with some of the constructs of 
legislation here, adding to that abundance, at the expense of those who 
have precious little. And so we can do better than this.
  One other gathering that I attended was for developmentally disabled, 
differently-abled individuals whose programs focus and strengthen their 
abilities, focus upon and strengthen their abilities; again, people 
approaching me saying: Keep up the fight for Medicaid.
  We cannot, our consumers cannot, do it. Our loved ones cannot do it 
without Medicaid. And I think the rejection of Medicaid expansion in 
this House that was offered by this House, by this town, by Washington, 
to the many States across the country, the rejection by those States, I 
believe, was sheer politics. And so, we denied people in States who pay 
Federal taxes the benefits of Medicaid expansion.
  What sense does that make? What heart does that show? We are better 
than that. We are better than that.
  Finally, I will say this, because I know we have colleagues who are 
looking to share their thoughts and their stories. I looked at some 
constituents this weekend, in the eyes, and in heartfelt conversation 
said: Do you think it is fair, do you think it is just to rip away 
healthcare from people so you can afford a tax cut for the very 
wealthy? Is it fair to deny preexisting condition coverage for 
individuals? Is it unfair to take it away?
  What about the essential health benefits package, those of our 
neighbors and friends who struggle, who live with mental illness and 
mental health disorders, those who are dealing with the illness of 
addiction? Is it fair not to help them?
  I looked at them, and I said: Okay, I know who you voted for. This is 
a nation where we have the freedom of choice. But when we vote for 
whomever, it is also our duty, our responsibility to see if they are 
acting accordingly. Do you think your candidate of choice is being fair 
and just?
  They couldn't answer me about that situation. They wanted to redirect 
the conversation. Why?
  Because I think it is difficult to say that people, leaders in this 
town, the President and leaders in the House and the leaders in the 
Senate, are not listening to America; and so it is unfair to utilize 
the sweeping of services, of healthcare and response to tens of 
millions of individuals and families, and utilize those dollars for a 
tax cut for the wealthy.
  We are going to watch this aggressively, with laser sharp focus. The 
people of America have spoken. They are continuing to speak. They don't 
like the injustices. They don't like the unfairness. They don't like 
the calculated ripping away of healthcare insurance for tens of 
millions of people. Whether it is 30, 23, 22, 21, whatever the 
iteration, shame on us for allowing something like that to happen.
  America deserves to be--as an industrialized nation that did not have 
access, affordability, and quality of care as givens for many 
households in this country, they need to express those terms in a much 
better format.

[[Page H6289]]

  Mr. Speaker, I thank Representative Garamendi for leading us in a 
discussion this hour to alert people to the fact that the Democrats in 
this House are still battling for those families that would have 
healthcare coverage ripped from them so that we can afford a tax cut 
for the wealthy.
  Mr. GARAMENDI. Mr. Speaker, I thank the gentleman from New York.
  The view from the great State of New York and the State of 
California, somewhere in between those two States lies the State of New 
Mexico. I yield to the gentlewoman from New Mexico (Ms. Michelle Lujan 
Grisham) to share with us the view from the great State of New Mexico.
  Ms. MICHELLE LUJAN GRISHAM of New Mexico. Mr. Speaker, I want to 
thank my colleague, Mr. Garamendi, and certainly thank Mr. Tonko for 
their incredible statements about what is really at risk and why it is 
at risk.
  I think it is very important for viewers, and our constituents, and 
families, to really understand that this is not a healthcare debate. 
This is not a healthcare reform measure.
  Nothing that has occurred and passed in the House or in the Senate 
has involved serious discussion or debate of any kind of healthcare 
reform because what this really is, as you stated, is a tax break, not 
just for the wealthiest of Americans, but for two critical 
corporations, insurance companies and pharmaceutical companies, who, I 
assure you, do not need additional tax breaks, who are still making 
record profits. And when we look at the pharmaceutical industry, in 
particular, it has been one of the most profitable industries in 
America's history.
  So this is an effort to provide more benefits to the three groups who 
do not need these benefits; and the way in which they pay for it is to 
remove healthcare benefits from millions of Americans. And as the 
gentleman pointed out, 32 million Americans are at risk of losing their 
healthcare, and many more who are in jeopardy of having to pay far more 
for the benefits that are necessary and lifesaving.
  I really wanted to weigh in because States like mine, rural, 
frontier, very poor States, in fact, we have the most to lose of any 
State in the Nation if this draconian measure, which is one step 
closer, is passed in the Senate after today's procedural vote.
  It means $11.4 billion out of our economy. It is a devastating blow 
to one of the poorest States in the Nation, who has one of the highest 
percentages of individuals in Medicaid to the expansion.
  For the first time in my lifetime, I am seeing New Mexicans in a 
position to have access to care, the right care at the right time at 
the right place. If this country is going to get healthcare right, then 
we have got to make sure that people have access so we are not the 
sickest population in one of the wealthiest countries in the world.
  The only way that you do that is providing access. We provide access 
in the Affordable Care Act by giving people subsidies and asking 
insurance companies to treat their beneficiaries and enrollees fairly, 
right? Subsidies to afford those premiums, by making sure that they 
have to cover preexisting conditions, by making sure that they are not 
making women and other populations pay more for their care.
  This is a Congress that has an obligation to address the things that 
both Republicans in Congress and pharmaceutical companies and insurance 
companies have done to us, not for us. Premiums are still too often too 
high; copays still too often too high; and deductibles, still too high.
  But is that the fault of the Democrats or an administration that 
worked to make sure that insurance companies got payments to deal with 
the rising costs of folks with serious catastrophic illnesses and 
chronic disease? No, it is Republicans who refuse to continue to fund 
those risk corridors and those cost-sharing mechanisms.
  Did we do anything in this Congress to require pharmaceutical 
companies who sell the very same drugs for 10 cents on a dollar to 
nations around the world, to make sure that you got a fair drug price, 
after your tax dollars helped those same pharmaceutical companies do 
the research required? And then we give them patent protections to make 
the most possible money, including now protections on generic brand 
drugs?
  No, we did nothing to hold that industry accountable, which would 
mean lower costs for consumers.
  But what I know happens for sure with this bill is, not only do they 
rip the rug out from under any of those protections by hardworking New 
Mexicans and hardworking Americans who deserve the protection and the 
knowledge that their healthcare will be there for them tomorrow, we 
also close every rural community health center, every rural hospital at 
risk in the country, which is why no hospitals, no doctors, no 
insurance companies, no pharmaceutical companies--because who are they 
going to sell these proceeds to--are supporting this bill.
  And the Senate is ignoring every Republican Governor whose State took 
up Medicaid, who is saying this is a disaster. They want something 
else.
  Yet this is the path we are under because it would be more important 
to give tax breaks than to do this--to protect Mr. Templeton in my 
State, who was diagnosed with prostate cancer in December 2016. He 
began treatments in January 2017.
  He explained in an email that, without the ACA, he is not able to 
afford any of his treatments. He said: ``Am I being sentenced to death 
by Congress? How many more U.S. citizens are out there like me?''
  The answer to Mr. Templeton's question is there are at least 32 
million.
  As I close with what I think is an outrageous effort by Republicans 
in the House and the Senate, and by that procedural vote in the Senate, 
is at the same time they are looking at ripping healthcare away from 
millions of Americans, they are willing to put $1.6 billion into a wall 
that they promised that Americans would not pay for.
  Here is an idea. You have got $1.6 billion to invest; invest that to 
protect folks with their costs under the ACA. Give more subsidies.
  Let's deal with Medicaid fairly. Let's make sure that we drop 
prescription drug costs. Let's lower copays. Let's invest in rural 
community health centers more. Let's have a targeted effort to deal, as 
you said, with opioid and substance abuse problems that were created by 
pharmaceutical companies. Let's do that.
  If you really care, this is money that would hire more nurses. This 
is money that would hire thousands more teachers. This is money that 
would put thousands of New Mexicans and Americans back to work in 
better, safer, more productive infrastructure for our futures--our very 
future, Mr. Garamendi, Mr. Speaker, at stake by the wrong path and the 
draconian efforts today in the Senate.
  I thank the gentleman for the opportunity to highlight how terrible 
these efforts are and how important it is for us to encourage our 
supporters to fight for fairness and justice in this country.

  Mr. GARAMENDI. Mr. Speaker, America has been enlightened by the 
gentlewoman's very forthright statement. The voice of New Mexico has 
been heard here on the House floor, Ms. Michelle Lujan Grisham. I 
cannot tell you how much I appreciate that message from New Mexico and 
what it means with the repeal of the Affordable Care Act. Thank you so 
very much for doing that, a very powerful statement, a very powerful 
voice on behalf of New Mexicans and Americans.
  Somewhere between New Mexico and New York lies the State of Ohio, 
and, Ms. Kaptur, you have represented that State so very well for a few 
years here. We won't say exactly how many years. But over those years, 
you have always been the voice for the working men and women of Ohio.
  Mr. Speaker, I yield to the gentlewoman from Ohio (Ms. Kaptur).
  Ms. KAPTUR. Mr. Speaker, I thank Congressman Garamendi and 
Congressman Tonko for their comments. It is a pleasure to be with them 
tonight, and also Congresswoman Michelle Lujan Grisham. She really has 
been such a leader, not just for New Mexico, but for the whole issue of 
health across our country. I am really pleased to join all of them.
  And I will just say, as a member of the Appropriations Committee, the 
American people should know, this past week we tried very hard to pass 
an amendment that would simply ask the executive branch to report back 
to us on how much money we were spending as a country in Medicare, 
Medicaid, at the VA, the Department of Defense, for certain classes of 
drugs in our country.

[[Page H6290]]

  Now, don't you think it would be right for us to know, since we are 
spending tax dollars, that if we are spending more money on, let's say, 
a diabetic medicine than a heart medicine, whatever medicine it is, it 
would be good for us to do cost accounting to go back and look at what 
we are paying?
  Do you know we were not able to get that simple reporting-back 
amendment on how much pharmaceuticals are costing the people of the 
United States, because the Republican members of our committee blocked 
it.

                              {time}  1900

  Ms. KAPTUR. They voted ``no.'' They don't want to know how much the 
American people are spending through their tax dollars at the Federal 
level because the goal is to figure out how this money was being spent 
and to hold those companies responsible to look at what costs were over 
time and so forth.
  It is amazing and it is really wrong what the pharmaceutical industry 
is doing to the people of this country. They are killing people. People 
cannot afford the medicine that they need.
  Yesterday, and I give this as homework, in The New York Times, there 
was a great story titled, ``When Health Law Isn't Enough, the Desperate 
Line Up at Tents.'' It was written by what must be a brilliant young 
reporter named Trip Gabriel, and it reported about a charity group in 
our country called the Remote Area Medical Expedition. They were in 
Wise, Virginia, somewhere south of here.
  What it is is a group of charitable citizens who are in optometry. 
They are doctors. They are dentists. They donate their time over a 
weekend, and they go to places in our country that don't have medical 
care.
  So no American should assume that everybody has care and that 
everybody has insurance, even with the current system.
  I will tell you, if you want your eyes opened, read that story.
  Over one weekend, over 2,000 people came. There were people there who 
were diabetic who had no medication. One woman, they reported in the 
story, came with a dispenser for insulin, but the needle was broken. 
Her glucose reading was over 500.
  They talked about people who were there for glasses. They couldn't 
afford glasses. One woman was diagnosed with vision of 20/100 in one 
eye, and they were looking for glasses that would fit her.
  They had a gentleman who was coughing, and he thought he had black 
lung disease. It turned out what he really had was sleep apnea. Finally 
somebody diagnosed what his problem was.
  They start out with the story about a gentleman who showed up at that 
event, and he took them to the trunk of his car and showed them the 
pliers he was using to rip out his teeth because he had so many decayed 
teeth and he hadn't been to the dentist in years. They had dentists. 
They had all kinds of physicians. They had nurses trying to help 
people.
  I read that article and I thought: This is America? This is America?
  Here are just the first few sentences, if I might. It says: ``Anthony 
Marino, 54, reached into his car trunk to show a pair of needle-nosed 
pliers like the ones he used to yank out a rotting tooth.
  ``Shirley Akers, 58, clutched a list of 20 medications she takes, 
before settling down to a sleepless night in the cab of a pickup truck.
  ``Robin Neal, 40, tried to inject herself with a used-up insulin pen, 
but it broke, and her blood sugar began to skyrocket.
  ``As the sun set in the mountains of southwest Virginia, hundreds of 
hurting souls were camped out or huddled in vehicles, eager for an 
early place in line when the gates swung open at 5 a.m. for the 
Nation's largest pop-up free clinic.''
  That free clinic is called the Remote Area Medical Expedition. I just 
read that. There were several photos in the paper. This is America.
  So, for the Senate, particularly the leader of Senate who comes from 
Kentucky, a State that is noted to have very poor medical care, where 
there are large rural areas where many people, including those who are 
single who get none of this coverage--right? The single are especially 
discriminated against--how that could be pushed forward by someone from 
the State of Kentucky, I simply don't understand it.
  And here in this House, where we tried so hard to save the Affordable 
Care Act and to make necessary changes to it, a lot of those changes 
are needed in these rural States that don't have enough people to 
really set up a large enough exchange. We need to lump two or three 
States together so you get a pool that is insurable. We know how to fix 
this. But we don't need to take more people off health insurance, 
millions and millions and millions, because we have millions who still 
are uninsured, and we have industries like the pharmaceutical industry 
fighting us against trying to get affordable medications to our 
constituents.
  I want to thank you for being here tonight and for fighting the good 
fight for the American people. Really, to have almost a trillion 
dollars of money given away over the next 10, 15 years to the 
wealthiest people in our country? You know what? They have doctors. 
They can afford insurance. Frankly, they don't need more money. They 
might benefit by a little less money, actually. Their heirs certainly 
would. We need a little rigor out there, even among the wealthy in our 
country, to help us to heal this Nation and to deal with its real 
medical problems.
  I will just say this. We were checking today on the diabetic costs 
across our country. One facility in Ohio, just one veterans facility, 
over 30,000 veterans in that facility have been diagnosed with 
diabetes. Many, many of those veterans go for the treatment of dialysis 
in order to help them to deal with their condition. For 1 year, that 
treatment costs $100,000. Over a 10-year period, it costs $1 million 
per person who goes through dialysis.
  Imagine if we were able to prescribe food as medicine, which 
hospitals are doing in many places, and help people learn how to not 
become so severely diabetic. We would save so much money across this 
country, including with our veterans. And more important than money, we 
would save their lives. We would save the amputations. We would save 
all of the costs that diabetes incurs over the years. So people would 
learn how to be healthier.
  I want to thank you for being here. I am proud of you two gentlemen, 
Congressman Garamendi and Congressman Tonko. You are honorable 
gentlemen. You have come here from both ends of the country, New York 
and California. We are here tonight because we know what the American 
people want. They want affordable healthcare. They want affordable 
medicine. They are willing to do their part, and nobody should be left 
out.

  We can find that answer as the United States of America. We don't 
have to accept this set of death panels that they are figuring out over 
there in the Senate: who is going to die, who is not going to have 
health insurance, who is going to be shortchanged. Because when that 
wheel of fortune turns, you never know who in your family is going to 
get sick. You simply don't know, and no one should be without coverage.
  I thank you for being here on the floor tonight and for doing what 
the American people expect us to do, and that is to defend and protect 
them.
  Mr. GARAMENDI. Ms. Kaptur, thank you for your comments. For years you 
have been the strong voice of working men and women in the State of 
Ohio. Thank you for bringing us the message from mid-America.
  Also, in your wrap-up, you began to talk about the issue of 
prevention. One of things that the Affordable Care Act does so very 
well--ObamaCare, if you will--is prevention, particularly for seniors. 
There is a free annual healthcare checkup for seniors as a result of 
the Affordable Care Act.
  When seniors get that healthcare checkup, they also are able to 
understand that they have high blood pressure, incipient diabetes or 
other illnesses that ultimately, as Ms. Kaptur so correctly pointed 
out, become extraordinarily expensive if they are not treated.
  One other fact is that the Medicaid program in America, more than 50 
percent of the total expenses in the Medicaid program are for men and 
women who are in the nursing homes. We are not just talking about 
families and

[[Page H6291]]

children. We are talking about the elderly that are being cared for in 
nursing homes.
  Now, the result of the repeal of the Affordable Care Act and the 
reduction of the Medicaid expenditure is that those men and women who 
are in the nursing homes will no longer have the support to keep them 
in a nursing home.
  So what comes of those men and women? What happens to them if they 
are no longer able to have care in a nursing home?
  Just let that question hang there because it is a question that our 
Republican colleagues and the Senate must answer, because the repeal 
and replace legislation or repeal legislation and wait legislation goes 
right to the heart of the Medicaid program and the support that enables 
those seniors in nursing homes to receive that service.
  In addition to that, what comes of the Medicare program? We know that 
the Medicare program solvency was significantly increased to about 15 
years. It is not going to go bankrupt in the near term as was predicted 
before the Affordable Care Act but, rather, extended into the out-
years. So the solvency of the Medicare program would be reduced, and 
the free medical checkups, we are not sure whether they would be able 
to continue or not.
  So it is not just men and women who are not yet 65 years of age, but 
it is men and women who are 65 that would see significant pressure on 
the services that they now receive, and quite probably reductions in 
the services that they would receive both in the Medicare as well as in 
the Medicaid program.
  Mr. Tonko, why don't we chat for a few moments back and forth here.
  You in New York, you are faced with the same problems that my 
constituents in California would be faced with, and that is a repeal 
seriously hurts people, I mean, physically hurts them. They will not be 
able to get the medical services that they currently have.
  I yield to the gentleman from New York.
  Mr. TONKO. I thank the gentleman from California for yielding, and, 
Representative Garamendi, I am so honored to associate my comments with 
those of yours, to connect with you in this effort to make certain that 
we stop this foolishness coming from this House and the United States 
Senate that totally rejects the pleas of Americans across this country 
to make certain that the dynamics that drove the Affordable Care Act 
still stay in place, and that being affordability, accessibility, and 
quality of care. Those are such essential forces. They are the 
underpinning of the foundation of the Affordable Care Act.
  When I heard your expression of concern here tonight and pinpointing 
those various elements of the positive reinforcement that comes from 
the Affordable Care Act legislation, hearing the voice of two 
Congresswomen here from New Mexico and Ohio on the floor joining us, it 
reminds me that our force is the essential force on the Hill in 
Washington to make certain that the people's voices are heard. There is 
anger out there, there is injustice, there is unfairness, and it has to 
be addressed.
  I am proud of the efforts that have been made in my State. I know 
that you talked about the progress in California. In New York, I am 
proud of what the Governor, Governor Cuomo, and the legislature did in 
building those exchanges. It took response from each of the 50 States 
to make this work, or at least we had hoped each State would respond 
fully. But in New York, we are managing that effort through sound 
exchanges.

  I get worried when I see tweets from the President when things didn't 
work for awhile in the Senate, when they couldn't move forward with the 
repeal or repeal and delay or repeal and replace: Well, we will just 
let the Affordable Care Act die of its own right.
  What are you talking about? That sounds to me like a poor attitude, 
one that wouldn't do the very best to underpin, through the agencies 
that are connected to this legislation, to reinforce the markets out 
there. That is part of this response.
  When I hear an attitude like that expressed, I am concerned about 
what the voice over to these agencies will be saying: Look, we need to 
be a good partner, a sound partner, an effective partner with the 
Affordable Care Act.
  I don't know if we would get that. So that worries me if your 
attitude is let it just die and crumble. Why? Why can't you put the 
American public before politics?
  Let's do our best effort. Let's, in earnest, do our best. Let's be 
genuine in our approach.
  I think it is absolutely incredible. You know, as the Republicans, 
Representative Garamendi, in the Senate race to pass TrumpCare, a bill 
that would rip coverage away from tens of millions of people, perhaps 
as many as 30 million--if you would allow me to share a few stories 
from my district, I think it is so important to put a face onto these 
discussions. I have documented some of the recent stories we have heard 
from constituents.
  Cathryn, a 30-year-old in my district, left work to return to school 
to pursue graduate studies in social work, and she used the ACA 
exchange, their plans, to bridge gaps in employer-based coverage.

                              {time}  1915

  The ACA plans provided her with essential preventative healthcare 
services and ensured that a major health event would not leave her 
bankrupt as she was doing what we asked people to do: develop your 
talent and your skills to serve the general public.
  So she was pursuing graduate studies. The security and affordability 
of Catherine's ACA plan was tremendously reassuring, allowing her to 
take risks in order to build a career in service to others. That is 
what the ACA afforded Catherine to do, a 30-year-old in my district.
  Robert, a 52-year-old in my district, purchased insurance on a 
healthcare exchange while suffering from diabetes. Before buying an 
exchange plan, Robert spent hundreds and hundreds of dollars each month 
just to purchase insulin, and no other health coverage.
  Because of the ban on discrimination that could be utilized against 
him based on his preexisting conditions, Robert can now afford a health 
plan that covers himself and his family.
  A couple of other examples, if you will allow me.
  Tracey, a 38-year-old from my district, a certified nursing 
assistant, needs multiple drug prescriptions to treat preexisting 
conditions, including diabetes. The Affordable Care Act has made it 
possible for Tracey to get health coverage for herself and her family. 
Without the ACA, Tracey would not be able to pay her doctors or her 
drug companies. As recently as January, Tracey was still paying off old 
bills for her medical care.
  This has provided hope for people. We need to make certain we don't 
have people digging deeper into their pockets for healthcare coverage. 
We want to relieve that pressure that is upon them. We want to make 
prescription drugs affordable. We want to make certain that 
efficiencies are there in the system so we can save, but get the care 
to people.
  That is the difference that we need to cite here. The contrast is 
that we are trying to make this ACA better and make it work, and we are 
asking for a bipartisan, bicameral, executive legislative partnership 
to make it better. Is that too much to ask?
  Let me share one more story.
  Elliot, a 56-year-old in the 20th Congressional District of New York 
lost his job in September last year after his company made a massive 
layoff, even though he just started his job. So through no fault of his 
own, he lost his employment. Elliot was then left to figure out how to 
support himself and his 19-year-old son who was a Syracuse University 
student. A COBRA plan would have cost $2,000 a month. Because of 
Medicaid, Elliot and his son now have quality health coverage as Elliot 
continues to look for work and his son is pursuing his college 
education.
  These are real stories, real hardships, real challenges, real help, 
real assistance that has come in the way of these families. We don't 
need to take that good news and suffocate it. We need to build upon 
these stories.
  Now, Senate Republicans are racing to pass a bill that would open the 
doors to less coverage, rip it away from tens of millions of people, 
and in many ways perhaps provide for an imposition of lifetime limits 
on care.
  What does that do?

[[Page H6292]]

  It is a death sentence for far too many people. It would impact 
severely upon those who are struggling with cancer--working their 
hardest to defeat that, working with their doctor, their medical 
community to defeat that impact of cancer in their lives--heart 
disease, and other long-term illnesses.
  My friends, this is about being a compassionate voice. It is about 
utilizing the advancements in medical care, technology, making 
affordable our healthcare system, making affordable prescription drug 
costs.
  There is improvements that we want to make, not give a tax cut for 
the rich, which has been a terrible response. People would say: Oh, the 
Affordable Care Act is not working.
  So if there were improvements required, be fair, be only honest with 
the public you represent, be there for them.
  Finally, the last point I will make right here is Medicaid and the 
changing profile of Medicaid in many of our States. In New York, people 
need to see where the growth in Medicaid is. And because we have a 
disproportionate senior population in upstate New York, you are seeing 
the growth of Medicaid the farther north you go.
  I ask my colleagues to be sensitive to their constituent base. Don't 
be heartless. Don't be cruel in the outcome. Walk away from this.
  The silence is deafening at times when it comes to some of the 
proposals being sent by leadership in this House and in the Senate. 
Silence is not what is called for here. Outspoken rejection of some of 
these harsh measures is what we need, and bipartisan cooperation, 
bicameral activity is what will serve the public best.
  So I thank the gentleman for yielding. I thank him for bringing us 
together in what is a very important discussion here in this Special 
Order.
  Mr. GARAMENDI. I thank Mr. Tonko so very much for his comments. He 
covered the issues very well.
  I want to go to two issues really quickly that need to, I think, be 
wrapped up here.
  First of all, the President talks about the Affordable Care Act 
dying, and it is not going to make it. That could happen because of 
actions that he is specifically telling the administration to take.
  There are three different areas, one of which is being very late in 
providing the cost-sharing funding programs for those people who are 
purchasing insurance. It is discretionary right now. We ought to make 
that mandatory and not given the President the option of not providing 
those funds. If those funds are not provided, then, yes, the exchanges 
will collapse.
  Secondly, we know that there is the cross subsidization from one 
insurance company to another called reinsurance that tries to balance 
out the risk pool of each individual insurance company. Some insurance 
companies, for many different reasons, wind up with a very high risk, 
high cost population. Others are able to have a very low risk. The risk 
needs to be balanced out between those two. If that is not done, then 
there will be a death spiral amongst the insurance companies.

  Thirdly, under the Affordable Care Act, people are mandated to buy 
insurance or else pay a penalty. That penalty is enforced by the 
Internal Revenue Service, which has been specifically given 
instructions by the President not to enforce the law. That will lead to 
those young and healthy invincibles not buying insurance because there 
is no penalty. That will cause the insurance pool to become more risky 
and, again, start that death spiral that is so much talked about.
  The death spiral can be avoided, and the Affordable Care Act is 
drafted and written in such a way as to avoid it. So my plea to the 
President is: Use the law. Do not cause the Affordable Care Act to 
collapse.
  Mr. Speaker, please pass on to the President that the President has 
within his power to maintain the Affordable Care Act. He also has 
within his power to cause the Affordable Care Act to collapse.
  Now, the final point--and help me with this, Mr. Tonko--is that the 
Democrats have known for 5 years that there are improvements that need 
to take place within the Affordable Care Act, and we have pleaded with 
our Republican colleagues to allow those improvements to take place. We 
have had a deaf ear from our Republican colleagues. So as we go into 
this possible crisis, let it be known that the Democrats are seeking 
improvements in a variety of areas. We heard about the drug prices. I 
know, Mr. Tonko, you were talking in your earlier presentation about 
some of the improvements that can be made. So jump in here. Interrupt 
me, if you will.
  Mr. TONKO. To repeat what my colleague just said, I will say that we 
want to work with the American public. We have said over and over again 
that it is about affordability, accessibility, quality of care. Share 
with us the improvements that you think will work. Let us know of the 
hurdles in the road that you have faced.
  Remind us that Medicaid serves the needs of our parents and 
grandparents in nursing homes. Remind us that those who are born with 
challenges in life are served well by healthcare coverage and Medicaid. 
Remind us that those living with developmental disabilities, showcasing 
their abilities requires Medicaid to make it work; chronic illnesses 
requiring an insurance clause that addresses preexisting conditions, 
building upon an essential health benefits package.
  We are with you. We walk with you. We raise our voices with you. We 
lift our hearts with you. We want to be victorious with you and for 
you. Let's not let them rip away this health insurance for the 
opportunity to provide tax cuts for the very wealthy.
  Again, I thank the gentleman for the opportunity to speak forcefully 
in this given Special Order. It is so important to save the Affordable 
Care Act, make it stronger, and respond to the needs of people across 
this country who are speaking out.
  Mr. GARAMENDI. I thank Mr. Tonko so very much, once again, from the 
East Coast and the West Coast, I hope, to a message that America has 
listened to.
  I just looked out here in the audience and I noticed that our 
colleague from Texas is here to speak.
  Mr. Speaker, I yield to the gentlewoman from Texas (Ms. Jackson Lee).
  Ms. JACKSON LEE. Mr. Speaker, I thank Mr. Garamendi for yielding. I 
was detained at another meeting, but I could not help but conclude our 
very important Special Order.
  And I do want to emphasize that we have a better deal. We have the 
opportunity to be able to stabilize the markets.
  We heard from Mr. Cohen today, who is from the great State of 
California, who says: The Affordable Care Act does work. Subsidies do 
work. And if we go the route of the Senate--the tragic vote today--
Americans will wind up paying more for premiums than their own income.
  So I join in saying we can fix and stabilize--fix the Affordable Care 
Act, stabilize the healthcare system, and ensure that 49 million people 
do not lose their insurance by 2026; or with the Senate bill, 32 
million don't lose their insurance.
  So I simply conclude with this: I met with a family who has an 
autistic child--a young woman who wants to live on her own. She can't 
do that without the Affordable Care Act.
  I met with a young man by the name of Matthew, who spent $700,000 
over a 2-year period because he has a chronic illness; $73,000 on his 
medication in the last 6 months. The American people need us to do for 
them what the government can do, and that is to ensure a healthcare 
system for all.
  That is what the Affordable Care Act's underlying premise is. That is 
what Democrats have as their message. Mr. Garamendi, I believe in 
saving lives. That is what I want to do with the Affordable Care Act.
  Mr. GARAMENDI. Mr. Speaker, I thank Ms. Jackson Lee very much for her 
comments.
  Indeed, we do look for a better deal, better jobs, better wages, 
better education. That is our goal, and we can do that.
  Mr. Speaker, I yield back the balance of my time.

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