[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.

                          ____________________