[Congressional Record Volume 163, Number 151 (Tuesday, September 19, 2017)]
[Senate]
[Pages S5827-S5831]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                               Healthcare

  Mr. SCHUMER. Mr. President, there is a possibility that by the end of 
next week, the Senate will have a vote again on a Republican healthcare 
bill assembled in the dark of night by one party, without a full 
account of what the bill would do. It will be a shameful return to the 
same process the majority used to try to ram a bill through in July, 
unsuccessfully.
  To consider a bill like this without a full CBO score is worse than 
negligent; it is grossly irresponsible. We were told yesterday that CBO 
may be able to provide a baseline estimate of the cost of the bill but 
not the coverage numbers or a detailed analysis of how the bill would 
affect Americans' healthcare choices.
  We are talking about one-sixth of the economy; we are talking about 
the healthcare of the Nation; we are talking about the lives, day in 
and day out, of millions of Americans who need healthcare; and we are 
not going to really know what the legislation does.
  Senators will be voting blind. They say justice is blind, but the 
Senators on the other side of the aisle should be walking around here 
with a blindfold over their eyes because they don't know what they are 
voting on. Maybe they don't care. I don't know how any Senator could go 
home to his or her constituents and explain why they voted for a major 
bill with major consequences to so many of their people without having 
specific answers about how it would impact their State.
  What we do know is that this new TrumpCare bill, the Graham-Cassidy 
legislation, is worse in many ways than the previous versions of 
TrumpCare. The new TrumpCare would devastate our healthcare system in 
five specific ways.
  First, it would cause millions to lose coverage.
  Second, it would radically restructure and deeply cut Medicaid, 
ending the program as we know it. It has been the dream of the hard 
right to get rid of Medicaid, which could happen, even though it is a 
program that affects the poor and so many in the middle-class--nursing 
homes, opioid treatment, people who have kids with serious illnesses.
  Third, it brings us back to the days when insurance companies could 
discriminate against people with preexisting conditions. The ban on 
discriminating against people with preexisting conditions would be 
gone. We have had a lot of promises from the other side that they would 
never vote for a bill that didn't protect people with preexisting 
conditions. That seems to be going by the wayside in a headlong rush to 
pass a bill so that they can claim a political victory. What about that 
mom or dad who finds out his or her son or daughter has cancer, and the 
insurance company says: Yes, we will cover you; it will cost you 
$50,000. And they don't have it, so they have to watch their child 
suffer. This was an advance that almost all Americans supported. It was 
an advance most people on the other side of the aisle believe in--gone.
  Fourth, the bill gets rid of the consumer protections that guarantee 
Americans' access to affordable maternity care, substance abuse 
treatment, and prescription drugs. All of those could be out of any 
plan. You can pay a lot for a plan and not get much for it in this 
bill.
  Fifth, it would throw the individual market into chaos immediately, 
increasing out-of-pocket costs for individual market consumers and 
resulting

[[Page S5828]]

in 15 million people losing coverage next year--15 million people.
  On the first point, the new TrumpCare would cause millions to lose 
health insurance in two ways: first by undoing the Affordable Care 
Act's major coverage expansion under Medicaid and premium and cost-
sharing assistance, instead putting that into an inadequate and 
temporary block grant, and, second, by radically restructuring and 
cutting the traditional Medicaid Program through a per capita cap.
  We don't have a CBO score yet, and we may not get one in time. But 
previous CBO scores of similar schemes have shown that 30 million 
Americans could lose coverage under this bill--30 million Americans--10 
percent, approximately, of our population.
  On the second point, the new TrumpCare would end Medicaid as we know 
it by converting Medicaid's current Federal-State financial partnership 
to a per capita cap, which cuts current Medicaid funding levels on an 
annual basis. This is a direct blow to nursing home patients and folks 
in opioid treatment, and CBO has said that 15 million fewer people 
would receive Medicaid under similar proposals.
  On the third point, the new TrumpCare actually brings back the 
ability of insurers to discriminate against folks with preexisting 
conditions, as I mentioned.
  Fourth, the new TrumpCare would no longer guarantee consumers 
affordable access to maternity care, substance abuse, and prescription 
drugs.
  Fifth, like previous repeal and replace, it would immediately 
eliminate the individual mandate, which would raise the number of 
uninsured by 15 million, relative to current law, in 2018 and increase 
market premiums by 20 percent.
  So vote for this bill, and right away 15 million will lose coverage, 
and premiums will go up by 20 percent. People who vote for this bill 
are not going to be happy with its results. Each one of these five 
things represents a major step backward for our healthcare system, 
bringing back discrimination against folks with preexisting conditions 
and ending Medicaid as we know it. These are overwhelmingly popular 
with Democrats, Independents, and Republicans. The hard right doesn't 
like it. The big financiers of the other party don't like entitlements, 
but Americans do. We are going to go backward--backward. We are going 
to go backward and not even know the effects.
  Why is the other side rushing this through? They are ashamed of it. 
They need to have that political scalp: See, we abolished ObamaCare. 
But what they are putting in its place, even for those who don't like 
ObamaCare, is worse. They don't want to know that. The joy they will 
have--misplaced joy, in my opinion--of abolishing ObamaCare will 
evaporate quite soon when their constituents feel the effects of this 
bill and they hear about it from average folks who are so hurt.
  The Washington Post summed up Graham-Cassidy yesterday. They said the 
bill ``would slash health-care spending more deeply and would probably 
cover fewer people than the July bill--which failed because of concerns 
over those details.''
  Republicans couldn't garner the 50 votes for their various healthcare 
plans earlier this year because of how much damage those plans did to 
Medicaid, how they rolled back protections for preexisting conditions, 
and some opposed it because the process was such a sham. Well, all 
three conditions are here again with this bill: cuts to Medicaid, no 
guarantee for preexisting conditions, a sham of a bill.
  There is a better approach. Right now, Chairman Alexander and Ranking 
Member Murray are working in a bipartisan way--holding hearings, 
working through committee, coming back and forth between the parties 
with discussions. Each side is going to have to give; that is how it 
works around here--or should work--in trying to get a proposal that 
will improve things. That is the kind of legislating many Members of 
the Senate have said they want to get back to. That is the kind of 
process worthy of the world's greatest deliberative body.
  After a rancorous and divisive healthcare debate, which took up the 
better part of this year, Democrats and Republicans have been working 
in good faith to come up with a bipartisan agreement on healthcare in 
the HELP Committee. The Republican majority would toss all of that away 
if they pursue Graham-Cassidy next week the way they are pursuing it--
returning to reconciliation, not working in the committees, no CBO 
report, making a mockery of regular order.
  I hope, for their sake and the country's sake, my Republican friends 
will turn back from this new TrumpCare and join us again on the road to 
bipartisanship. We have seen bipartisan sprouts bloom in the last 
month. Graham-Cassidy would snuff them out. Nobody wants that--nobody.
  I yield the floor.
  The ACTING PRESIDENT pro tempore. The assistant Democratic leader.
  Mr. DURBIN. Mr. President, what is the business of the Senate this 
morning?
  The ACTING PRESIDENT pro tempore. The Senate is considering the 
Francisco nomination.
  Mr. DURBIN. I ask unanimous consent to speak as in morning business.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Mr. DURBIN. Mr. President, I wish to say that the comments made by 
the Democratic leader, the Senator from New York, really touched me 
because they go to the heart of this institution.
  It was only a few weeks ago, in a dramatic moment, when Senator John 
McCain returned from Arizona to come to the floor of the Senate and 
cast a historic vote to move forward on the debate on healthcare. He 
asked for 15 minutes after that vote to say a few words about his 
experience as a person and his observations as a Senator, and I stayed 
in my chair because I wanted to hear him.
  John McCain came to the House of Representatives the same year I was 
elected. Our careers have at least been close or parallel in some 
respects, though I couldn't hold a candle to him in terms of his 
personal life experience and his experience in the military, as well as 
being a candidate for even higher office.
  I listened carefully as he reminded us of what it takes for the 
Senate to work. What it takes, of course, is the determination of both 
political parties to solve a problem. He reminded us that means sitting 
down in committee, with experts, working through some of these issues, 
particularly the more complex issues--the give-and-take of the 
legislative process.
  He pointed specifically to the effort to repeal ObamaCare as a 
failure by those standards. He used as an example the fact that 
ObamaCare, during the period of Republicans' efforts to repeal, was 
actually gaining popularity in this country--exactly the opposite of 
what the other party might have expected. It was an indication to him 
that we needed to do things better in Senate. Just a few days later, he 
cast a critical vote to stop what was a flawed process on the 
Republican side--to repeal ObamaCare without a good alternative, 
without a good substitute.
  I remember that vote early in the morning, right here in the well of 
the Chamber, and I remember what followed when I saw Senator Lamar 
Alexander and Senator Murray behind me in front of the cloakroom in a 
bit of a huddle after that historic vote. I later learned that they had 
decided it was their turn to step up on a bipartisan basis and find a 
way to strengthen our healthcare system, not what we had just seen but 
a different way--a way that kind of relied on experts at State levels 
to give us advice and experts in Washington to really cull through the 
ideas to find the very best. They invited other Members of the Senate 
to join them, even those of us not on the committee.
  Senator Alexander and Senator Murray have had several meetings, which 
I have attended and which were very productive meetings--bipartisan 
gatherings over coffee and donuts with insurance commissioners from 
States all across the Nation, commissioners from both political 
parties, bipartisan meetings of Governors from States all across the 
United States. They were basically sitting down and saying: What can we 
do now? What can we all agree to do, regardless of party, that will 
reduce the increasing costs of health insurance premiums, provide 
coverage for more people, and provide better healthcare--quality care? 
It was a good-faith effort, and it was encouraging, after 7 wasted 
months of political debate on the floor of the Senate.

[[Page S5829]]

  I went to those meetings and came away feeling very positive. It was 
clear that some very basic ideas were emerging from all over the United 
States. One of the ideas was cost-sharing reduction so that health 
insurance companies that took on sicker, older patients and had worse 
loss experiences would be able to be compensated so they could reduce 
premium costs, bring the cost of health insurance down, and make sure 
more people had it available.
  Another proposal was reinsurance. That is the same basic idea. Let's 
find a way to make the increase in health insurance premiums slow down. 
I remember the commissioner from the State of South Carolina, a 
Republican, who said that his experience was that in the next year, 
health insurance premiums in the individual marketplace were going up 
30 percent.
  He said that, if you bring in the cost-sharing reductions, which the 
Federal Government can do, it would only be 10 percent. Ten percent is 
bad enough. Thirty percent is painful.
  Here is something we can do on a bipartisan basis to reduce the cost 
of health insurance premiums. It struck me as obvious that this is what 
we should be doing as the Senate.
  I applauded Senator Alexander personally and publicly, and Senator 
Murray, as well, for doing what the Senate was supposed to do. Little 
did I know that at the same time they were making this bipartisan 
effort, there was another Republican effort under way to derail them, 
to stop them, to end the bipartisan conversation that was under way in 
the HELP Committee.
  The Cassidy-Graham proposal, which may come to the floor as early as 
next week, is an effort to repeal ObamaCare, but it is a flawed effort.
  Earlier this morning, the Republican leader came to the floor and 
spoke of the debate that we have had over and over about what we are 
going to do in the future, and he talked about the failed ideas of the 
past. I can tell you that the Cassidy-Graham proposal is a return to 
failed ideas--ideas rejected once by the Senate but certainly by the 
American people.
  In this morning's Chicago Tribune, one of the business writers, 
Michael Hiltzik, wrote an article entitled ``The GOP's last-ditch 
ObamaCare repeal bill may be the worst one yet.''
  Mr. President, I ask unanimous consent to have printed in the Record 
this article in its entirety.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

               [From the Chicago Tribune, Sept. 16, 2017]

  The GOP's Last-Ditch Obamacare Repeal Bill May Be the Worst One Yet

                          (By Michael Hiltzik)

       The Republican effort to repeal the Affordable Care Act is 
     back, a zombie again on the march weeks after it was declared 
     dead. The newest incarnation is Cassidy-Graham, named after 
     chief sponsors Bill Cassidy of Louisiana and Lindsey Graham 
     of South Carolina.
       Compared with its predecessors, the bill would increase the 
     ranks of America's medically uninsured more--by millions of 
     people--cost state governments billions more and pave the way 
     for the elimination of all protection for those with 
     preexisting medical conditions.
       Among the biggest losers of federal funding would be the 
     states that had the foresight to expand Medicaid under the 
     Affordable Care Act and the resolve to reach out to lower-
     income residents to get them coverage; they'd be punished 
     with draconian cuts in healthcare funding. Among the big 
     winners would be states that have done nothing of the kind 
     for their residents--refusing the Medicaid expansion and 
     interfering with outreach efforts. They'd be rewarded for 
     their stupidity and inhumanity with an increase in federal 
     funds.
       Over the last week or so, reviews of the measure have been 
     pouring in from healthcare experts, and they're almost 
     unanimously negative. Major health provider and consumer 
     organizations have turned thumbs down, as have analysts 
     looking at its economic effects.
       Fitch Ratings, which keeps an eagle eye on the fiscal 
     condition of states issuing bonds, judges Cassidy-Graham 
     ``more disruptive for most states than prior Republican 
     efforts.'' Fitch finds that ``states that expanded Medicaid 
     access to the newly eligible population under the Affordable 
     Care Act (ACA) are particularly at risk under this latest 
     bill.''
       The bill surfaced just as the political tide seemed to be 
     shifting away from the GOP campaign to roll back the gains in 
     health coverage experienced by Americans over the last seven 
     years under the Affordable Care Act. Democrats are coalescing 
     around universal health coverage--``single-payer,'' as it's 
     typically termed--teeing up the issue for the 2018 election. 
     It's notable that the rise in public support for this 
     approach, at least in the abstract, has coincided with the 
     GOP's so-far unsuccessful repeal effort. The emergence of the 
     new bill also comes as other Republicans are scheduling 
     hearings and reaching across the partisan aisle to craft a 
     sensible plan to shore up the Affordable Care Act 
     marketplace.
       Despite those drawbacks, Cassidy, Graham and their co-
     sponsors are trying to push the measure through by Sept 30, 
     the last day it could be passed with only 50 votes (plus a 
     tie-breaker cast by Vice President Mike Pence) under Senate 
     reconciliation rules. After that, it would need a filibuster-
     proof count of 60 votes, meaning it could--and presumably 
     would--be blocked by Democrats. The deadline places more 
     pressure on the Congressional Budget Office, which must 
     analyze the bill before it can come to a vote, to move fast.
       In recent days, the sponsors have claimed that their vote 
     count is edging toward 50. But Sen. Rand Paul (R-Ky.) has 
     stated that he's a ``no,'' since the bill isn't conservative 
     enough for his taste. Sen. Susan Collins (R-Maine), whose 
     ``no'' vote helped to scuttle the last repeal effort in July, 
     isn't expected to change her mind on this one. Sen. Lisa 
     Murkowski (R-Alaska), who also voted it down, hasn't been 
     quoted on her position, but there don't seem to be compelling 
     reasons for her to shift to the ``yes'' column now. The 
     position of Sen. John McCain (R-Ariz.), who also voted 
     against the last bill, isn't clear, but he's a close friend 
     and frequent ally of Graham's. In any event, the backers 
     still seem to be a vote or two short.
       Those are the procedural issues. Now let's turn to the 
     text, and the issue of why anyone would think Cassidy-Graham 
     would improve America's healthcare system.
       In broad terms, the measure would terminate the Affordable 
     Care Act's Medicaid expansion, premium and cost-sharing 
     reduction subsidies, tax credits for small businesses, and a 
     host of other pro-consumer provisions by 2020. It would 
     eliminate the act's individual and employer mandates 
     retroactive to Dec. 31, 2015.
       The bill provides for no replacement of these provisions, 
     beyond a capped block grant to states. In effect, it's a 
     repeal-and-no-replace bill. The Congressional Budget Office, 
     as it happens, analyzed that approach in July in connection 
     with a different bill. It found that by 2026 the number of 
     uninsured Americans would increase by 32 million, compared 
     with under current law. That's about 50% more people 
     uninsured than it estimated for other Republican repeal-and-
     replace measures, which the budget office said would cut 
     enrollments by 20 million to 22 million.
       The block grant to states, which Cassidy and Graham portray 
     as one of their bill's chief virtues, is in fact a poisoned 
     chalice any governor would be a fool to accept. The proposal, 
     Cassidy said in unveiling the bill, ``gives states 
     significant latitude over how the dollars are used to best 
     take care of the unique healthcare needs of the patients in 
     each state.'' That papers over its significant drawbacks.
       By their nature, when block grants are proposed to replace 
     existing programs, they're almost always back-door mechanisms 
     to reduce federal spending. That's the case here. The 
     Cassidy-Graham block grants would replace the money now being 
     spent on Medicaid expansion and the premium and cost-sharing 
     subsidies, and a couple of other spending provisions. But the 
     existing spending is pegged to demand--Medicaid funding 
     adjusts automatically to enrollment and the medical needs of 
     the enrollees, and the subsidies are pegged to enrollee 
     incomes and the premiums charged by insurers for benchmark 
     Obamacare plans.
       Block grants would be fixed, changing only according to a 
     complex formula. And that formula would be ``insufficient to 
     maintain coverage levels equivalent to the ACA,'' the Center 
     on Budget and Policy Priorities calculated last week. Between 
     2020 and 2026, the center reckoned, the grant would provide 
     $239 billion less than projected federal spending for the 
     existing Medicaid expansion and subsidies. In 2026 alone, the 
     shortfall in Medicaid and subsidy funds together would total 
     $80 billion.
       What's worse is that the grant would be unable to respond 
     to real-world conditions. Consider how healthcare costs are 
     likely to rise in Texas and Florida in response to this 
     summer's floods, which drove thousands of residents out of 
     their homes and increased the threat of water-borne disease. 
     They'd get no help from the block-grant formula. To provide 
     needed care to their residents under Medicaid or any other 
     state programs, they'd have no choice other than to limit 
     enrollments, cut benefits, charge higher premiums or co-pays, 
     or drain funds from other federally funded programs.
       As set forth in the bill, the formula would ``over time 
     move money away from states, predominantly Democratic, that 
     have expanded Medicaid and aggressively pursued enrolling 
     their lower income populations in Medicaid and exchange 
     coverage,'' observes healthcare expert Timothy S. Jost. 
     ``Money would move toward states, predominantly Republican, 
     that have not expanded Medicaid.''
       Some Medicaid expansion states would lose as much as 60% of 
     what they would be due under current law. According to the 
     numbers crunched by the Center on Budget and Policy 
     Priorities, among the states that went all-in on Obamacare, 
     including expanding Medicaid and mounting aggressive 
     enrollment support

[[Page S5830]]

     for the marketplaces, California would get $27.8 billion less 
     in federal funding in 2026, New York $18.9 billion less, and 
     Massachusetts $5.1 billion less.
       States that shunned the Affordable Care Act would make out 
     like bandits: Texas, which showed absolutely no regard for 
     its ACA-eligible population, would get $8.2 billion more in 
     2026, and Mississippi, another black hole for healthcare 
     reform, would get $1.4 billion more. This is how carrot-and-
     stick approaches to healthcare reform work--in the Bizarro 
     world. (Apologies to Jerry Seinfeld.) In any case, all the 
     federal funding would disappear after 2026, According to 
     Fitch, ``over time even non-expansion states will face 
     budgetary challenges given the proposed changes to Medicaid, 
     which will likely accelerate for all states over time.''
       Another provision of Cassidy-Graham that is significantly 
     worse than its predecessors is the latitude it gives states 
     to eviscerate consumer-protection rules in the Affordable 
     Care Act. The bill would allow states to request waivers from 
     the federal government allowing them to nullify the act's 
     requirement that all policies include 10 essential health 
     benefits, including maternity care, hospitalization, mental 
     health and substance abuse treatment, and prescription 
     coverage. This is an invitation to states to allow insurers 
     to market junk insurance to their residents.
       The states could also request waivers of the act's all-
     important protections for people with preexisting medical 
     conditions. The law forbids insurers to charge anyone more 
     based on their medical condition or history, except for a 
     modest increase in premiums based on age and a surcharge for 
     smokers. Previous GOP repeal bills have substituted a 
     ``continuous coverage'' provision, which protects applicants 
     who haven't let their coverage lapse for a month or two from 
     being surcharged when they renew.
       Cassidy-Graham throws out that protection. It would allow 
     states to request a waiver allowing insurers to charge more 
     ``as a condition of enrollment or continued enrollment . . . 
     on the basis of any health status-related factor.'' 
     Translation: Under such a waiver, insurers could check 
     applicants' health or medical histories before setting 
     premiums--even for renewals.
       Finally, there's that crucial Republican litmus test--
     abortion. The bill bars any insurance policy receiving 
     federal funds--that is, a policy whose enrollees get 
     subsidies or that is subject to payments under the Affordable 
     Care Act's reinsurance rule--from offering coverage for 
     abortions except when the mother's life is in jeopardy or in 
     cases of rape or incest.
       Remarkably, this bill's sponsors are pitching it as a 
     moderate, common-sense alternative to its predecessors. They 
     may also be hoping that opposition fatigue has set in, and 
     that they'll be able to steamroll the measure through while 
     the public is distracted by other issues. As with other 
     repeal efforts, this one is being brought out without a 
     minute of hearings.
       Cassidy asserts that this measure is a blow for equality. 
     The measure ``treats all Americans the same no matter where 
     they live.'' He's right, in a way: It treats all Americans as 
     potential victims of insurance company profiteering.

  Mr. DURBIN. Let me quote a few sentences from this article because I 
think they make the case dramatically about how bad the Cassidy-Graham 
substitute would be. Here is what he said:

       Compared with its predecessors, the bill would increase the 
     ranks of America's medically uninsured more--by millions of 
     people--cost state governments billions more and pave the way 
     for the elimination of all protection for those with 
     preexisting medical conditions.

  He goes on to say:

       Among the biggest losers of federal funding would be the 
     states that had the foresight to expand Medicaid under the 
     Affordable Care Act and the resolve to reach out to lower-
     income residents [and provide health insurance] coverage.

  He goes on to say that, under this Cassidy-Graham bill, ``they'd be 
punished with draconian cuts in healthcare funding.''
  He goes on to write:

       Among the big winners would be the states that have done 
     nothing of the kind for their residents--refusing the 
     Medicaid expansion and interfering with outreach efforts [to 
     bring more people into health insurance coverage].

  They would be rewarded, perversely, for doing the wrong thing.
  He writes:

       Over the last week or so, reviews of the measure have been 
     pouring in from healthcare experts, and they're almost 
     unanimously negative. Major health provider and consumer 
     organizations have turned thumbs down, as have analysts 
     looking at its economic effects.

  He talks about the impact of this bill beyond increasing Federal 
funding for States that did not help their residents and cutting 
Federal funding for States that did. The bill provides no replacements 
for the tax credits available for small businesses and the subsidies 
for health insurance premiums currently in the law beyond a capped 
block grant to States.
  He writes:

       In effect, it's a repeal-and-no-replace bill. The 
     Congressional Budget Office, as it happens, analyzed that 
     approach in July in connection with a different bill. It 
     found that by 2026 the number of uninsured Americans would 
     increase by 32 million, compared with under current law. 
     That's about 50% more people uninsured than it estimated for 
     other Republican repeal-and-replace measures, which the 
     budget office said could cut enrollments by 20 million to 22 
     million.

  Honestly, can my colleagues on the other side of the aisle in good 
conscience go home to their States and say: I voted to repeal ObamaCare 
and you are going to lose your health insurance as a result of it.
  I can tell you what it means in my State. A million people would lose 
their health insurance because of this Republican repeal effort. I 
don't know how Members of Congress--House or Senate--from Illinois 
could in good conscience vote to take health insurance away from 
massive numbers of Americans.
  We are blessed here. Those of us who serve in Congress have access to 
good health insurance. It is not cheap. It shouldn't be. But it is 
there. It is always there, and we don't have to worry about it. Some 
Members are wealthy enough that they take care of it in other ways. For 
most Members of Congress, we use the insurance marketplace and pay our 
share of the premiums. The government pays a share of it, just as it 
does for Federal employees.
  We have access to health insurance. How then could we turn and say to 
the people we represent: I just voted for a bill to take away your 
access to health insurance.
  That is what this Cassidy-Graham bill does. That to me is hard to 
imagine--that a Member can believe they were elected to the Senate for 
that purpose.
  What does it do to the States with this capped block grant in terms 
of their loss of Federal funds? It is amazing. Some States would lose 
as much as 60 percent of what they currently receive under the current 
law.

       According to the numbers crunched by the Center on Budget 
     Policy Priorities, among the states that went all-in on 
     Obamacare, including expanding Medicaid and mounting 
     aggressive enrollment support for the marketplaces, 
     California would get $27.8 billion less in federal funding in 
     2026, New York $18.9 billion less, and Massachusetts $5.1 
     billion less.

  I looked at the list for my State of Illinois. It would lose $1.4 
billion in Federal funding by 2026. Just to show the contrast, as for 
the State of Texas, which did not expand Medicaid and which did not 
cover low-income individuals with health insurance, what would the 
Cassidy-Graham bill do for the State of Texas? They wouldn't lose a 
penny. They would add in Federal funding $8,234 million.
  They would be big winners because they turned their back on low-
income individuals and didn't expand Medicaid or increase the number of 
enrollees. What a perverse incentive for Governors and governments on a 
State basis to turn down coverage knowing that at some point they will 
be rewarded for that approach.

       Another provision of Cassidy-Graham that is significantly 
     worse than its predecessors is the latitude it gives states 
     to eviscerate consumer-protection rules in the Affordable 
     Care Act.

  One of the most important parts of the Affordable Care Act was a 
reform that said: If you are going to buy health insurance, it is going 
to be there when you need it. First, you will be able to buy it, even 
if you have someone in your family with a preexisting condition. That 
is one of the first casualties of Cassidy-Graham--going back to a 
failed idea in the past, which said if you have a sick baby or if you 
have a spouse who survived cancer, you either can't buy health 
insurance or you can't afford it. We got rid of that once and for all. 
At least we thought we did. Cassidy-Graham brings it back to life. It 
says: Let the insurers decide if they want to cover you or not.
  Another thing we said is that the disparity in premium costs between 
the most expensive policy and the least will be 3 to 1. Cassidy-Graham 
tosses it out and says it is 5 to 1. What it means--and AARP knows this 
better than any other organization--is that senior citizens are going 
to end up paying more for their health insurance under Cassidy-Graham 
than they currently do under the Affordable Care Act.

[[Page S5831]]

  When you look at the other protections that we built in to provide 
that your policy, when you bought it, would cover mental illness and 
substance abuse treatment, that is considered revolutionary but 
important. Finally, after all of these years in America, we are looking 
at mental illness as an illness rather than a curse. We are looking at 
it as something that can be successfully treated. Yet here comes 
Cassidy-Graham tossing out that requirement as well.
  Let the insurers decide what they want to offer. I was talking to one 
of the Republican Senators the other day, and he said: Well, you know, 
some people just may not want to buy certain coverage.
  I can understand that, but I can also understand the reality of life. 
Who can predict that next year or next month you would learn that 
perhaps your high school daughter has been taking opioids and now is 
addicted to heroin? You didn't know it before, not when you bought your 
health insurance policy. Now that you know it, who is going to cover 
the substance abuse treatment?
  Under the Affordable Care Act, it is built into your health insurance 
policy. Under the Cassidy-Graham approach, it is an option. Try it if 
you like it. It doesn't work in a lot of circumstances. We buy 
insurance for things we pray will never happen, but we want to be 
covered in case they do. Cassidy-Graham walks away from that. They are 
for what they call ``flexibility.'' It is flexibility to buy insurance 
that isn't there when you really need it.
  When you look at the litany of all of the States that are winners and 
losers under Cassidy-Graham, you have to shake your head. Why would we 
be richly rewarding States that have not done their part to expand 
Medicaid coverage? Why would we devastate the Medicaid Program, which 
is so important for so many people?
  Medicaid is a program that many people didn't understand until we got 
into this debate, but it is a program that is essential if you have a 
disabled child.
  A woman in Champaign, IL, with a young son in his twenties suffering 
from autism told me that without Medicaid coverage he would have to be 
institutionalized, and there is no way her family could afford it.
  We know that Medicaid is there for that family and for many low-
income families when it comes to pregnancies, to make sure that mom has 
a successful pregnancy and that the baby is born healthy and ready to 
thrive.
  Is that an important asset? Of course it is, and it is an important 
element of Medicaid. The one thing that costs the most in Medicaid is 
something the Republicans don't want to acknowledge, and that is the 
fact that two out of three people in nursing homes--seniors who are 
under medical care--rely on Medicaid. Without that Medicaid assistance, 
who is going to pay that bill? The family reaching into their savings? 
Some can, but most will not be able to afford it.
  How will the Republicans explain that away as just one of the 
benefits of flexibility--that Medicaid is not there when your parent or 
grandparent desperately needs it?
  So now we have this debate before us, which will come up by the end 
of next week, and it is one that really will affect a lot of people 
across America. I, for one, will do everything I can to stop this. Any 
program that is going to take health insurance away from a million 
people in Illinois and up to 30 million nationwide is a bad start, a 
bad idea, a failed idea.
  I yield the floor.
  I suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. DURBIN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.