[Congressional Record Volume 165, Number 123 (Monday, July 22, 2019)]
[Senate]
[Pages S4960-S4961]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                               Healthcare

  Mr. CASEY. Mr. President, I rise to speak about an issue that, 
candidly, we don't talk enough about around here, and that is the 
threat to the Affordable Care Act and the lawsuit that was filed and is 
now in a Federal court. This time, it is in the Circuit Court of 
Appeals for the Fifth Circuit.
  Earlier this month, there were oral arguments. This case could be 
decided in a short timeframe, maybe even this fall. I guess, because it 
is not an issue that is being debated in the Halls of Congress by way 
of hearings or votes or otherwise, it doesn't get the attention it 
warrants.
  This lawsuit, which is now a direct challenge to the 
constitutionality of the Patient Protection and Affordable Care Act, 
would be every bit as devastating and harmful as the repeal efforts 
that were undertaken two summers ago, in 2017, and the consequences of 
the success in that lawsuit would put the country in the same place it 
would have been had the repeal effort been successful.
  If you want to simplify it, the Affordable Care Act has two parts to 
it. We know, for example, of the protections that were put in place in 
the Affordable Care Act, one was new protections, and the other was new 
coverage. So, roughly, 20 million people got coverage who didn't have 
coverage before. Most of those 20 million, at the time--or a higher 
number at least--were folks who had gained their healthcare coverage 
through Medicaid expansion. As we now know, Medicaid expansion has had 
a number of positive impacts on the American people.
  It really came into force--came into effect--right in the middle of 
or in one of the early stages of our broader awareness of the opioid 
crisis, of the addiction crisis. Were it not for the expansion of 
Medicaid, a lot of people in my home State of Pennsylvania and around 
the country would not have had treatment for opioid misuse or for the 
broader category of substance use disorder conditions. Medicaid 
expansion has helped a lot of people with treatment, which is essential 
to freeing yourself from the grip of an addiction we have seen so 
often.
  This lawsuit was successful in the district court. If it were to be 
affirmed, for example, in the Fifth Circuit, it would mean this court 
would declare the Affordable Care Act as unconstitutional. The effect 
of that would be that Medicaid expansion would go away--protections for 
a much larger number of Americans, not simply those who need opioid 
treatment or treatment for opioid addictions or for substance use 
disorder conditions and not just for those who have been newly 
enrolled--for the roughly 20 million who have gotten coverage.
  When you are talking about the protections, you are talking about a 
much larger number of Americans--maybe as high as 150 million Americans 
or more--who have protections not only in the circumstances in which 
they had preexisting conditions but also protections against capping 
the coverage one would get or the treatment one would get over a year 
or over a lifetime, which is just to mention two or three new 
protections. For example, it would go away for all of those young 
people who have been able to stay on their parents' health insurance 
plans until the age of 26. So you are talking about a tremendous 
coverage loss of at least millions of people--potentially as high as 
20-plus million people--and the elimination of protections for tens and 
tens and tens of millions of Americans.
  You would think, in that circumstance, those who have been most 
determined to have the Affordable Care Act struck down--because they 
have

[[Page S4961]]

had about 8 years now, give or take, to prepare something with which to 
replace it--would have a replacement ready to go, maybe a replacement 
enacted into law, but at least a replacement that is ready to go on day 
one that would have all of the details worked out. This would not be 
just any replacement--not just a replacement that has words like 
``preexisting conditions'' in the title of the bill--but something real 
and substantial and credible on a complicated subject like healthcare, 
meaning that the replacement would cover at least 20 million people, 
would provide all of the protections for all of those Americans, 
whether it is on protections against a preexisting condition or 
otherwise, and would be comparable in its positive impact on Americans. 
You would think this bill would be ready to go and ready to be enacted 
into law, but that is not the case.
  I shouldn't say I was surprised, but I was somewhat concerned when--I 
guess it was last week, about a week ago--I picked up POLITICO and read 
that a number of Republican Senators were expressing the hope that the 
lawsuit would be successful, the hope that the Affordable Care Act 
would be declared unconstitutional. Yet what I didn't see in that 
article and didn't see in a lot of other places is a replacement that 
will provide a comparable, if not identical, measure of protection. 
That is what they told us all along--right?--that they have another 
way to do it and that all of the American people are going to be better 
off because of it. That is the basic promise that has been made by the 
Republicans in the Senate and in the House over many years. So you 
would think it would be ready, but it apparently is not ready.

  I hope that maybe in the month of August, the plan will be developed 
and be ready to go and not just any old plan that has a nice title on 
it and a surge of protections that can't be brought to fruition--or 
brought into effect--because, when you provide the kind of protections 
the Affordable Care Act provides, you have to make the math work. You 
have to make sure you can pay for it, and you have to make sure the 
policy will support what you promise in the details of the legislation.
  We will see what happens. If this lawsuit were to be affirmed at the 
circuit court level, I am assuming there would be an appeal by one side 
or the other. Yet, if we reach a point at which a court says the ACA is 
unconstitutional, I hope there is going to be a replacement that will 
provide all of the protections, all of the coverage, and all of the 
essential elements that were in the Affordable Care Act but that they 
will be done in a better way because that is what they have all 
promised on the other side. I don't think it is likely to happen. 
Something is going to give. Something will be cut. Something will be 
taken away or a lot more than that.
  By way of an example, I will use only one number for today--642,000. 
I think it is 642,700. That is the estimate of the number of children 
who live in Pennsylvania who have preexisting conditions. So any change 
in law by way of a court--a Federal court or the Supreme Court or 
otherwise--or any change in law pursuant to congressional action has to 
make sure, among many things, that every one of those 642,700 children 
in Pennsylvania has protections in place by law for preexisting 
conditions in addition to covering all of the other adults across 
Pennsylvania.
  Basically, it is almost one out of every two Americans who has a 
preexisting condition. That is the rough estimate. That is a lot of 
people across the country. Some people believe, as well as there being 
some credible, reliable estimates, that it is north of 130 million 
Americans. So those are the only two numbers I will give.
  The lawsuit is problematic. If that were all, that would be bad 
enough, but there are two things that are problematic when it comes to 
healthcare. One is that of the proposed cuts by the administration. 
Now, I realize House Republicans and Senate Republicans may not agree 
with the President's proposal, but he is in the same party, and his 
Budget Director is in the same party, and the Congress of the United 
States has to react to that budget proposal.
  The administration proposed a 10-year Medicaid cut of $1.5 trillion, 
and that is with a ``t''--trillion--not billion. The administration 
proposed a $1.5 trillion cut to Medicaid. It proposed a similar cut--
or, I should say, a comparable cut but actually a lower number--to 
Medicare over 10 years of $845 billion. You have to be able to say: OK, 
if it is the case that there is a credible replacement that provides 
the identical protections and coverage that the Affordable Care Act 
provided, what would happen to healthcare if you were to cut Medicaid 
by $1.5 trillion and Medicare by $845 billion?
  You have to answer those questions if you are serious about 
healthcare. Now, if you are just kind of moving things around and 
having a talking point for a campaign, maybe that is different, but if 
you are serious about healthcare and if you are serious about coverage 
and if you are serious about there being an adverse impact on kids, on 
people with disabilities, and on seniors, you can't cut Medicaid by 
$1.5 trillion.
  One way to describe Medicaid is in the nursing home program for the 
middle class, in many instances. Medicaid is not a program for someone 
distant out there who is not worthy of our support and our help. 
Medicaid is about us. Medicaid is who we are because we decided more 
than 50 years ago that we are the United States of America, and we are 
the strongest country in the world for lots of reasons. Thank goodness 
we have the strongest military, and thank goodness we have the 
strongest economy. Yet we are also the greatest country in the world 
because folks around the world have seen they can follow our example 
once in a while. They saw more than 50 years ago that we said, if you 
are a child in a low-income family or if you have a disability or if 
you are a senior who is trying to get into a nursing home, Medicaid is 
going to help you do that. We also passed Medicare at the same time.
  So if you are serious about healthcare, you have to be really 
concerned about these budget cut proposals by the administration.
  The third and last topic on this is the efforts undertaken by the 
administration, when in the midst of failing to repeal the Affordable 
Care Act and, thereafter, the efforts to sabotage the Affordable Care 
Act--and not in any way an overstatement--when you have an advertising 
budget to let people know that they can go to the exchanges--not the 
Medicaid expansion but the exchanges--to get healthcare coverage and to 
get a subsidy to help them purchase healthcare--maybe for the first 
time, millions of people got that opportunity, and millions still have 
it--in order for folks to know about that, to know about their 
eligibility, to know about the benefits of that, you have to advertise. 
We know that. The administration cut the advertising budget by only 90 
percent--not quite 100 but a 90-percent cut in the advertising budget.
  There are also other ways they have undermined and sabotaged the 
system. If you are concerned about healthcare, you have to be concerned 
about that sabotage, you have to be concerned about Medicaid and 
Medicare cuts, and you have to be concerned about this lawsuit.
  We have a lot of work to do just to protect the gains--the coverage 
gains and the protection gains--that have been hard won over many years 
that benefit tens and tens of millions of Americans. I am not sure I 
can put a total number on them. So I hope those who are rooting for 
this lawsuit to be successful will have factored in all of that when 
that day comes, if it were to come, to change healthcare radically and 
dramatically for the American people.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Sullivan). The majority leader.

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