[Congressional Record Volume 163, Number 154 (Tuesday, September 26, 2017)]
[Senate]
[Pages S6127-S6128]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                               HEALTHCARE

  Mrs. FEINSTEIN. Mr. President, I rise in strong opposition to the 
Republican healthcare bill known as Graham-Cassidy. You would expect 
that Republicans' fourth attempt to repeal the Affordable Care Act 
would be better than the previous three. In fact, the opposite is true. 
This bill is the worst of the four bills.
  This is especially personal for me because the bill hurts California 
more than any other State. Before I get to this attack on my home 
State, I would like to list just a few of the many ways this bill harms 
millions of Americans and puts countless lives at risk.
  This bill boots at least 32 million Americans off healthcare. There 
is no sugarcoating it; Graham-Cassidy cuts health insurance subsidies 
and slashes Medicaid funding. That will mean fewer people with 
healthcare, plain and simple.
  The bill ends guaranteed protections for those with preexisting 
conditions. Anyone who says otherwise is not telling the truth. This 
bill says that States can allow insurance companies to charge those 
with preexisting conditions whatever they want. That means an end to 
guaranteed coverage because people with health conditions would be 
charged so much they wouldn't be able to afford coverage. Arguments to 
the contrary are just wrong.
  This bill not only eliminates the Medicaid expansion, it ends 
Medicaid as we have known it since 1965. The Medicaid expansion in the 
Affordable Care Act has meant 15 million more vulnerable Americans have 
gained insurance. With those funds gone, they lose coverage. By 
radically changing traditional Medicaid, States would have to either 
cover hundreds of billions in additional costs or kick people off 
Medicaid. Again, fewer people with coverage, more lives at risk--these 
are facts, and they are indisputable.
  This bill is also devastating for women's health. It ends the 
guarantee that maternity care, contraception, and other critical 
services women need will be covered and bars women on Medicaid from 
accessing Planned Parenthood, which is the primary healthcare provider 
for millions of American women. We hear so much from the other side 
about the importance of being able to choose your doctor. This bill 
says that, if you have chosen a doctor at Planned Parenthood, too bad. 
It doesn't matter how much you like that doctor; you need to find 
someone else.
  The bill also takes us back to the days of junk plans, when you could 
faithfully pay your premium and then discover you weren't covered when 
you got sick. The Affordable Care Act required all insurance companies 
to cover essential health benefits like cancer treatment, maternity 
care, prescriptions, and mental health. Graham-Cassidy says States can 
waive that protection.
  Those items I described affect all Americans, but as I said, this 
bill is also a direct attack on California and other Democratic States. 
When the Supreme Court ruled that the Affordable Care Act couldn't 
require States to expand Medicaid to cover more families, some 
Republican States used that as a way to attack President Obama's 
legacy. Never mind that they were risking their own constituents' 
lives, it was a political win for them.
  Now, Graham-Cassidy proposes taking Federal funds away from those 
States that did expand Medicaid and give it to those that refused. In 
California alone, 4 million have health insurance today because my 
State decided to accept the Federal Government's 90 percent 
contribution for a small 10 percent buy-in. Graham-Cassidy would end 
that, pulling the rug out from under those Californians. To say this is 
unconscionable is an understatement.
  What is worse, the bill's authors openly admit this is their 
strategy--to redirect money from States like California and New York to 
Republican States. Senator Cassidy said he is just trying to create 
``parity,'' but the reason there isn't parity is because Republican 
Governors and legislatures chose to put politics over people's health. 
States can choose at any time to opt-in and receive the 90 percent 
match for Medicaid expansion. Candidly, it is a revolting way to get a 
bill passed
  The one part of this bill that is the same as past versions is the 
dire cuts to Medicaid. This needs to be repeated: The only thing 
congressional Republicans have agreed on throughout this entire process 
is that children, pregnant women, people with disabilities, and seniors 
in nursing homes get too much healthcare.
  For any of my colleagues who don't realize the full extent of what 
Medicaid does for this country, allow me to explain. Gutting Medicaid 
would devastate care for children, particularly those with disabilities 
and complex healthcare needs. If anything in Washington were 
untouchable, I would think it would be providing healthcare to sick 
children, but apparently not.
  Each Republican healthcare bill in the House and Senate goes far 
beyond just repealing the Affordable Care Act. It essentially ends 
Medicaid as we have known it since 1965, the year President Lyndon 
Johnson created the program. Today, Medicaid covers 36 million 
children, including 5 million in California. That is nearly half of all 
children in this country. The program has always been a partnership 
between the States and the Federal Government. The Federal Government 
has paid a fixed share of all healthcare costs for Medicaid 
beneficiaries.
  Republicans want to end that partnership. Their plan would place 
strict limits on Federal payments, with States responsible for all 
costs above that limit. We don't have a full CBO score of this bill, so 
we don't have the exact numbers, but outside estimates of the total 
cuts in this bill show States losing over $4 trillion over the next two 
decades. Let me repeat that figure: over $4 trillion of cuts to 
Medicaid and health insurance subsidies within a generation.
  California alone would be required to pay $139 billion more between 
2020 and 2027, and over the next 20 years, it would cost my State $800 
billion. These cuts would be backbreaking and force many States to make 
extremely hard choices. If California couldn't come up with tens of 
billions of dollars more each year, millions of residents could lose 
their Medicaid coverage. California's Medicaid director said, ``Nothing 
is safe--no population, no services.''
  In July, I visited UCSF Benioff Children's Hospital in San Francisco. 
I met with three mothers--Kristin, Sally, and Nina. Their children--
Maggie, Megan, and Drew--have struggled with extraordinary healthcare 
needs including cerebral palsy, a congenital heart defect, and VATER 
syndrome, which is a set of complex birth defects. If it weren't for 
the first-class care they received at Benioff, they wouldn't have 
survived.

  These mothers are heroes. They have dedicated their lives to their 
children, doing all they can to ensure they lead full, happy lives in 
the face of such significant adversity. When I asked them how they and 
their children cope, Nina told me that you simply do your best to live 
the life you have.
  All three of these families are middle class. They are covered by 
employer-sponsored private insurance, but Medicaid fills the 
significant gaps in coverage. It covers in-home nurses to provide 
around-the-clock care, as well as first-rate medical equipment--
services that private insurance doesn't cover. Without in-home care, 
their children would have been placed in institutions to ensure access 
to critical around-the-clock care.
  If the Senate passes a bill that guts Medicaid, mothers like these 
may not be able to keep their children at home.

[[Page S6128]]

That is a stunning indictment of a party that proclaims its commitment 
to ``family values.'' One of the first areas where these cuts could 
show themselves would be our country's 220 top-rate children's 
hospitals. On average, 60 percent of patients at these hospitals are 
covered by Medicaid. In some facilities, that number is as high as 80 
percent. Those hospitals would inevitably need to reduce services and 
consolidate locations. Their ability to stay open would be threatened.
  You don't need to take my word on this point. The doctors and 
healthcare professionals who run children's hospitals have made this 
point crystal clear. Dr. Michael Anderson, CEO of Benioff Children's 
says, ``Graham-Cassidy will be devastating to sick children and their 
families. If Graham-Cassidy is implemented, children with complex 
illnesses will be more likely to have less funding available to them 
than what they actually need.''
  Dr. Paul Viviano, CEO of Children's Hospital Los Angeles--one of the 
country's top 10 children's hospitals--said previously that the cuts 
like this to the Medicaid Program would ``threaten'' their programs and 
``put at risk life-saving services.'' The reach of these cuts would 
extend far beyond patients who rely on the Medicaid Program. That is 
because the research and training of specialists at children's 
hospitals improves care for children nationwide. If specialists aren't 
available or are never trained, that hurts all children. Todd 
Suntrapak, CEO of Valley Children's in Madera, CA, told me that gutting 
Medicaid ``threatens the very viability of pediatric health care in 
this country.''
  Gutting Medicaid also threatens the wide range of supplemental 
services like speech and physical therapy that allow children with 
disabilities to thrive. Many of the letters and calls I have received 
in opposition to the bill have been from mothers advocating on behalf 
of their children with disabilities because they know these cuts would 
hurt their families.
  Beth from Davis, CA, has a son named Patrick with Down syndrome. 
Patrick also battled leukemia as a child. Despite the challenges he has 
faced, Patrick will soon graduate from high school. His mom expects him 
to secure a job and live independently because of the support he 
receives through California's regional center programs.
  Medicaid provides the vast majority of the $2.5 billion in Federal 
funding that our 21 regional center programs receive to facilitate job-
training, physical therapy, and other supports for those with 
disabilities. Beth wrote to me that her family has ``every reason to 
believe that Patrick will be a tax-paying Californian and we can't 
wait!'' Gutting Medicaid puts the services that have allowed Patrick to 
be in a position to graduate from high school on the chopping block.
  I would like to close by reminding my Republican colleagues that, if 
they pass this bill, they are effectively abandoning families during 
the most painful and difficult times in their lives--telling them they 
are on their own. I don't believe that is the type of country we are, 
and it is up to Senate Republicans to prove it. Stop advocating the 
dangerous repeal of the Affordable Care Act. Instead, let's stabilize 
its funding and improve it so it works for all Americans.

                          ____________________