[Congressional Record Volume 163, Number 151 (Tuesday, September 19, 2017)]
[Senate]
[Pages S5833-S5835]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
Healthcare
Mr. MARKEY. Mr. President, in July, millions of Americans awoke from
a months-long nightmare, as the Senate did the right thing and voted
down multiple Republican proposals to repeal the Affordable Care Act.
The American people breathed a sigh of relief when the future of their
healthcare and of their children's healthcare was safe for the time
being.
Unfortunately, Republicans want us to go back to that nightmarish
time by reigniting their proposal to threaten healthcare coverage for
millions of Americans. While the bill the Republicans are supporting
today may have a new name, it contains the same mean, devastating
policies. It is a zombie bill that despite best efforts and against the
will of the American people, will not die.
Like its TrumpCare predecessors, the Graham-Cassidy bill will result
in less coverage and increased costs. It eliminates the built-in
protections for Americans with preexisting conditions, causing many of
them to see their premiums skyrocket just because of a diagnosis. Some
experts estimated that an individual with diabetes could face a premium
surcharge of $5,600 under Graham-Cassidy.
Graham-Cassidy will also allow States to decide what insurers have to
cover and what they don't; meaning, once again, your ability to have
comprehensive healthcare coverage would depend upon where you live.
This is not the type of healthcare reform people in this country want
or need, and it is certainly not the type of reform to help us overcome
our Nation's opioid use disorder epidemic.
With 91 Americans dying every day from an opioid overdose, we are
clearly in the midst of our Nation's preeminent public health crisis.
Over these last few months, we have heard time and time again that
access to substance use disorder care is the linchpin to stemming the
continually rising tide of opioid overdoses. Unfortunately, it appears
our Republican colleagues have not been listening.
To be fair, access to treatment today is still a challenge. Only 1 in
10 people with substance use disorders receive treatment. Right now, an
estimated 2 million people with an opioid addiction are not receiving
any treatment for their disorder.
Yet the solution is not to block-grant funds which would otherwise be
used to help people get care for their substance use disorders. The
answer is also not kicking people off their insurance, but that is what
my Republican colleagues are yet again proposing to do.
As with the previous versions of TrumpCare, Graham-Cassidy would
threaten insurance coverage for 2.8 million Americans with a substance
use disorder. It would end Medicaid expansion and cap the program,
slashing its funding and decapitating access to lifesaving care. This
bill would simply take a machete to Medicaid--the leading payer of
behavioral healthcare services, including substance abuse treatment.
Also, in the same vein as earlier proposals, Graham-Cassidy would
allow States to waive the essential health benefits the Patients' Bill
of Rights put in place under the Affordable Care Act that ensures that
every plan provides comprehensive coverage. Because covering mental
health and substance use disorder treatment is expensive, this would
likely be one of the first benefits to be cut. As a result, someone
struggling with opioid use disorder would have to pay thousands of
dollars in out-of-pocket costs, likely forcing many to forgo lifesaving
substance use disorder care.
This epidemic of opioid abuse and overdose deaths will only get worse
as long as we have a system that makes it easier to abuse drugs than to
get help for substance use disorders. Graham-Cassidy would only
exacerbate this already dire problem in our country.
Just last week, a leading sponsor of the bill said: ``We recognize
there are circumstances where states that expanded Medicaid will have
to really ratchet down their coverage.'' ``Rachet down,'' that is not
improving healthcare. That is ripping insurance coverage away from the
one in three Americans struggling with opioid use disorder who relies
on Medicaid. That is gutting billions of dollars in addiction care and
treatment.
Graham-Cassidy isn't a new block grant program, it is a chopping
block program--for Medicaid, for coverage, for access to critical
substance use disorder services.
I believe past is prologue here. Just as Americans rejected the
inhumane and immoral TrumpCare of months past, they are already seeing
this new attempt is more of the same and, in some cases, worse. Many
patient, provider, and other healthcare groups have already come out
against Graham-Cassidy, citing the bill's inability to maintain the
healthcare coverage and consumer protections currently provided in the
Affordable Care Act. It is deja vu.
Enough is enough. Republicans newest shortsighted stunt is detracting
attention from bipartisan efforts to stabilize the individual insurance
market and to help decrease costs. Let's end this partisan gambit to
repeal and replace the Affordable Care Act and start focusing on ways
to make the healthcare system in our country better, not worse.
We need all of you, in every corner of the country, to once again
stand up and fight against these mean attempts to harm the health of
our family members, our friends, and our neighbors. We need your
energy, your commitment, and your passion to do what you did a few
months back to help make sure our better angels once again will
prevail. You have done it before, and I know you can do it again.
My Democratic colleagues and I will be fighting right here with you
to finally put this zombie healthcare bill to rest.
This is the time. This Chamber will be the place where we have this
debate within the next week on whether there is going to be a
destruction of the Affordable Care Act, a destruction of the promise of
access to healthcare for every American. The Republicans are coming
back, once again, to try to destroy that promise.
The Republicans harbor an ancient animosity toward the goal of
ensuring that there is, in fact, universal coverage for every single
American; that it is a right and not a privilege. What they want to do
is to leave these programs as debt-soaked relics of the promises that
have been made to ensure that there is, in fact, coverage for every
American.
So this is going to be the debate.
Daniel Patrick Moynihan, the great Senator from New York, used to say
that when you do not want to help a program or to hurt a program, you
engage in benign neglect--benign neglect. What the Republicans are
doing is engaging in a program of designed neglect--of ensuring, after
this designed program is put in place, that there is a reduction in
coverage, that there are fewer people who get the help they need, that
older people have to pay more, that fewer people get access, and that
Planned Parenthood is defunded. It is all part of a program of designed
neglect of the healthcare of all Americans.
This is a historic battle. It was not completed in July. Now, in the
next 10 days, we must complete this fight and make sure they are not
successful.
Mr. President, I yield the floor.
I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The bill clerk proceeded to call the roll.
Ms. KLOBUCHAR. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
[[Page S5834]]
The PRESIDING OFFICER. Without objection, it is so ordered.
Ms. KLOBUCHAR. Mr. President, I rise to join my colleagues on the
floor to share concerns I have been hearing from people in my State
about the latest healthcare repeal bill.
Minnesotans and patient groups, such as AARP, oppose this bill
because eliminating the Medicaid expansion and the Affordable Care
Act's help for millions of people means they would lose coverage, and
it would increase their out-of-pocket costs.
People in my State are concerned about this bill's impact on rural
hospitals, especially--as are the rural hospitals--because it makes
deep cuts to Medicaid, and the new block grant in the bill would end
completely by 2027.
I am very concerned that this bill would reverse the progress we are
making in addressing the opioid epidemic by putting a cap on Medicaid,
a program that has been critical for substance abuse treatment for
people struggling with this addiction.
A few months ago, I pointed out that we were on plan F in the Senate.
Plans A and B were the two House versions of a repeal; plans C and D
were the two Senate versions of the repeal; plan E was the repeal bill
without a replacement plan; and then we were presented with plan F.
That, of course, went down after the Senate Democrats were joined by
three Republican Senators in voting it down. I actually thought we
couldn't get lower than F, but apparently we can because now we are
here.
Many of the Minnesotans I have talked to don't like A, B, C, D, E, F,
or the plan we are discussing that has been proposed. I have heard from
people all over my State. At the Minnesota State Fair, I heard from
Democrats, Republicans, and Independents. I heard from people from our
cities and people from our rural areas. There are a lot of people--
nearly 2 million people--at the Minnesota State Fair, which is the
biggest State fair in the country. A lot of people stopped by my booth.
I heard from the old and the young, from men and women, cancer
survivors, people with disabilities, and many more. None of them wanted
us to keep going down a partisan path when it comes to healthcare.
That is why I was so happy to tell them over the recess that new
work--bipartisan work--was being done with Senator Alexander and
Senator Murray, two Senators who proved that they could work across the
aisle on the education bill, which they did last year. They are the
leaders on the Health, Education, Labor, and Pensions Committee, and
they have been moving forward together with truly bipartisan hearings
and discussions. I have attended a number of them with Governors and
with experts on this issue to figure out the best ways to strengthen
the individual markets and to reduce costs. That is something we have
done successfully in our State with an all-Republican legislature and a
Democratic Governor. We worked on it in our State, so I figured we
could maybe bring this out on the national level. But it isn't enough
that the work that is going on with Senator Alexander and Senator
Murray on a bipartisan basis could be imploded in favor of another
version of a repeal bill that hasn't even gone to a hearing before the
HELP Committee in regular order, as we would expect--the regular order
Senator McCain spoke up for in the incredible speech he gave when he
came back to the Senate. If that isn't enough, we heard yesterday that
we will not even be able to get a full Congressional Budget Office
analysis of this bill this month. Why would we rush to take a vote
before we have that critical information?
I have repeatedly heard my colleagues criticize moving forward with
bills when we don't know their impact. Our constituents are owed this.
This is the entire healthcare system of America. Why would we be taking
a vote on a bill when we don't even know the full impact--when we do
not have a full score of the bill--either financially or, most
honestly, the impact it would have on people's healthcare? Our
constituents are owed this. It is their healthcare and their money we
are messing around with.
When I talk to my constituents, none of them ask me to do what we
already know this bill does. It cuts Medicaid, eliminates the Medicaid
expansion, threatens protections for people with preexisting
conditions, and kicks people off their insurance coverage. Instead,
they want us to work together on bipartisan solutions to fix what we
have when it comes to healthcare: to strengthen the exchanges, support
small businesses, reform delivery systems, and lower the cost of
prescription drugs. I don't see anything in this bill that would lower
the cost of prescription drugs--nothing.
I have heard the same message from senior groups and the Children's
Hospital Association, which are strongly opposed to this bill. I have
heard the same message from the American Heart Association, the
American Diabetes Association, the American Cancer Society, and several
other patient groups that have said this ``proposal just repackages the
problematic provisions'' of the bills that were voted down earlier this
summer.
This bill, the Graham-Cassidy bill, is not the only option. Instead
of making these kinds of cuts and moving backward, Senator Alexander
and Senator Murray have invited all Senators, as I noted, to
participate in their process. They have had dozens of Senators show up
at early morning breakfasts or, as Senator Alexander calls them,
coffees, with 30, 40 Senators showing up. I know because I was there.
Why do they show up? Because they know we must make changes to the
Affordable Care Act. They also know, based on the work we have seen in
Minnesota and other places, these changes can be made across the aisle.
In these hearings and discussions on bipartisan solutions, we have
talked about the State-based reinsurance program passed in Minnesota.
While we are still waiting for the Federal waiver--I will make a pitch
for this at this moment--from the administration, even passing it alone
helped us to bring promised rates down. I know Alaska has a State-based
reinsurance program and recently got approval from the administration,
and New Hampshire and other States are pursuing similar plans. That is
why I support Senator Kaine and Senator Carper's legislation, the
Individual Health Insurance Marketplace Improvement Act, to reestablish
a Federal reinsurance program. This bill would lower premiums by
providing support for high-cost patients.
Another topic we have discussed frequently as part of the HELP
Committee process over the past few weeks is the cost-sharing reduction
payments. These are crucial to stabilizing the individual market and
reducing uncertainty. That is why I support Senator Shaheen's
Marketplace Certainty Act.
It is clear that this type of legislation could get support from both
sides of the aisle to improve the system, but beyond these immediate
fixes, it is long past time that we come together to pass legislation
to address the skyrocketing costs of prescription drugs. I have a bill
that would harness the negotiating power of 41 million seniors on
Medicare to bring drug prices down. Right now, Medicare is actually
banned by law from using their market power to negotiate for better
prices. I would bet on 41 million seniors for getting better prices,
but we are not giving them that chance.
Senator McCain and I have a bill to allow Americans to bring in safe,
less expensive drugs from Canada.
Senator Lee and I have a bill that would allow temporary importation
of safe drugs that have been on the market in another country for at
least 10 years when there isn't a healthy competition for that drug in
this country. This would let patients access safe, less expensive
drugs.
Senator Grassley and I have a bill which would stop something called
pay-for-delay, where big pharmaceutical companies actually pay off
generic companies to keep less expensive drugs off the market. That
bill would save taxpayers $2.9 billion and a similar amount for
individual consumers.
Are those bills in this latest proposal from our Republican
colleagues? No, they are not. Instead, what does this bill do? While it
devastates the Medicaid Program, it repeals big parts of the Affordable
Care Act that help people afford insurance and, instead, puts in place
an inadequate block grant which completely goes away in 10 years. This
bill does the opposite of what the people came up to me and talked to
me about in my State over the August break.
So before we rush through a vote on it, before we even know the
impact of
[[Page S5835]]
it, before it has even gone through the committee process as it is
supposed to do, before we even give an opportunity for Senator Lamar
Alexander and Senator Patty Murray--the two leaders on the committee
that matters for healthcare--to come up with their plan, no, the
proposal would be to rush the vote on this, and that is just wrong.
What is this in real terms? It is a woman from Pine Island, MN. Her
husband has struggled with mental illness for years, but she told me
she felt so fortunate that he was able to get mental health treatment
through their insurance coverage. She is worried that if these types of
repeal efforts succeed, people like her husband will go back to being
desperate for help.
This debate is about people with preexisting conditions who would see
their costs skyrocket under this bill. Teri from my State has ovarian
cancer. Unfortunately, it is not the first time she has had it. She
said that when she was diagnosed back in 2010, she ended up declaring
bankruptcy due to the cost of her treatment. Teri said bankruptcy was
``just a reality for a lot of people with cancer.''
Luckily, under the Affordable Care Act, Teri can afford insurance and
is currently responding well to treatment, which, by the way--I see
Senator Durbin here--is based on NIH-funded research. It is treatment
based on that research, which, unfortunately, we cut back on in the
bill, and Senator Durbin will continue to fight to get that treatment
through the Department of Defense included.
But the bill we are facing now, the Graham-Cassidy bill, would allow
insurers to charge sick people or those with preexisting conditions
much more than healthy people. Teri is worried that it would make it
difficult, if not impossible, for people like her to afford health
insurance.
This debate is about all the parents whom I have spoken to over the
last few months who have children with disabilities. These parents
would literally come up to me at parades over the summer, bring their
kids over in the middle of the parade route, and introduce those
children to me--kids in wheelchairs, kids with Down syndrome--and say:
This is a preexisting condition. This is what a preexisting condition
looks like. That is why they oppose repeal.
In Minnesota, one out of four children get their health coverage from
Medicaid, and 39 percent of our children with disabilities or special
healthcare rely on Medicaid or children's health insurance. We should
be spending our time this week reauthorizing the Children's Health
Insurance Program before States like mine run out of money at the end
of the month, before debating another repeal bill for which we don't
even have a Congressional Budget Office score on the impact. That word
``score'' sounds technical, but it is about what the bill would mean to
people like those kids who came up to me in the parades with their
parents and to people, like Teri, with ovarian cancer.
This debate is also about our seniors and our rural communities. Our
hospitals are essential to rural communities. They don't just provide
health services; they employ thousands of doctors, nurses, pharmacists,
and other healthcare workers. These rural hospitals often operate at
margins of less than 1 percent. That is one reason Senator Grassley and
I introduced the Rural Emergency Acute Care Hospital Act a few months
ago to help rural hospitals stay open. But cutting Medicaid by billions
of dollars and repealing the Medicaid expansion would move us in the
opposite direction.
In my State, Medicaid covers one out of five people living in rural
areas. I know my colleagues, Senators Collins, Capito, and Murkowski,
have previously expressed real concerns about the impact of Medicaid
cuts in their States, which also have big rural populations. Cutting
Medicaid and eliminating the Medicaid expansion doesn't just threaten
healthcare coverage for these populations; it threatens the local
communities where these hospitals are located.
These rural hospitals are on the frontlines of one important fight;
that is, the fight against the opioid epidemic. We just found out that
in our State last year, over 600 people died from opioid and other drug
overdoses--over 600 people. That is about two per day. It is more
people than we see die from car crashes in our State. It is more people
than we see die from homicide. Deaths from prescription drugs now claim
more lives than either of those two issues. This epidemic affects our
seniors too. One in three Medicare part D beneficiaries received a
prescription opioid last year.
While there is much more work to do to combat the epidemic, I want to
recognize the progress we have made with the CARA Act and the Cures
Act, with all the work that has been done, but making cuts to Medicaid
will move us in the other direction.
We have all heard the voices, not just of those on the frontlines of
the opioid crisis but from doctors and hospitals, patients, seniors,
nursing homes, and schools saying that this bill is not the way
forward. Instead, let's do what we all heard people wanted us to do in
August; that is, to work across the aisle on actual solutions that help
people afford healthcare.
I yield the floor.
The PRESIDING OFFICER. Under the previous rule, all postcloture time
has expired.
The question is, Will the Senate advise and consent to the Francisco
nomination?
Mr. DURBIN. Mr. President, I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There appears to be a sufficient second.
The clerk will call the roll.
Mr. CORNYN. The following Senators are necessarily absent: the
Senator from Mississippi (Mr. Cochran) and the Senator from Kansas (Mr.
Moran).
Mr. DURBIN. I announce that the Senator from New Jersey (Mr.
Menendez) is necessarily absent.
The PRESIDING OFFICER (Mr. Cruz). Are there any other Senators in the
Chamber desiring to vote?
The result was announced--yeas 50, nays 47, as follows:
[Rollcall Vote No. 201 Ex.]
YEAS--50
Alexander
Barrasso
Blunt
Boozman
Burr
Capito
Cassidy
Collins
Corker
Cornyn
Cotton
Crapo
Cruz
Daines
Enzi
Ernst
Fischer
Flake
Gardner
Graham
Grassley
Hatch
Heller
Hoeven
Inhofe
Isakson
Johnson
Kennedy
Lankford
Lee
McCain
McConnell
Murkowski
Paul
Perdue
Portman
Risch
Roberts
Rounds
Rubio
Sasse
Scott
Shelby
Strange
Sullivan
Thune
Tillis
Toomey
Wicker
Young
NAYS--47
Baldwin
Bennet
Blumenthal
Booker
Brown
Cantwell
Cardin
Carper
Casey
Coons
Cortez Masto
Donnelly
Duckworth
Durbin
Feinstein
Franken
Gillibrand
Harris
Hassan
Heinrich
Heitkamp
Hirono
Kaine
King
Klobuchar
Leahy
Manchin
Markey
McCaskill
Merkley
Murphy
Murray
Nelson
Peters
Reed
Sanders
Schatz
Schumer
Shaheen
Stabenow
Tester
Udall
Van Hollen
Warner
Warren
Whitehouse
Wyden
NOT VOTING--3
Cochran
Menendez
Moran
The nomination was confirmed.
The PRESIDING OFFICER. The Senator from Alaska.
Ms. MURKOWSKI. Mr. President, I ask unanimous consent that with
respect to the Francisco nomination, the motion to reconsider be
considered made and laid upon the table and the President be
immediately notified of the Senate's action.
The PRESIDING OFFICER. Without objection, it is so ordered.
____________________