[Congressional Record Volume 165, Number 198 (Wednesday, December 11, 2019)]
[Senate]
[Pages S6968-S6970]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                               Healthcare

  Mr. CASEY. Mr. President, I rise this morning, or I guess this 
afternoon, to talk about a couple of issues. I will start with 
healthcare and talk about the Supplemental Nutrition Assistance 
Program, as well as another piece of legislation we are considering in 
the next couple of days.
  Let me start with healthcare. There is a lot to talk about here. We 
don't have time for all of it today, but a number of things are 
happening on the healthcare front that I think most Americans are aware 
of but maybe have not heard a lot about recently.
  I would argue there are three basic threats to healthcare right now--
not just healthcare for some but, in large measure, healthcare for all. 
One is a lawsuit, which is being litigated in the Fifth Circuit Court 
of Appeals. It is a lawsuit that would wipe out the Affordable Care 
Act, and that lawsuit has already prevailed at the district court 
level. It is now before the appellate court, and if that lawsuit were 
to prevail, the Affordable Care Act--or I

[[Page S6969]]

should say it by its full name--the Patient Protection and Affordable 
Care Act would be declared unconstitutional. That would have 
ramifications not only for those 20 million who got covered--coverage 
they didn't have before--but also the tens of millions who have 
protections they never had before the act was passed in 2010.
  If you have a preexisting condition, for example--roughly, one out of 
two Americans has a preexisting condition--if you have one, you should 
be very concerned about the result of that lawsuit, the determination 
of which could be made in a matter of days or weeks. That is a big 
threat. That is the biggest threat to healthcare for virtually every 
American or at least every American family.
  The second big threat to healthcare is what the administration has 
undertaken since day one of the Trump administration, and that is the 
sabotage of the existing system in this regard, especially with respect 
to the insurance exchanges. What the administration has done is try to 
take administrative action, action by agencies under the President's 
jurisdiction, to undermine the exchanges.
  How do they do that? Well, they cut the advertising. So when they 
advertise to say that you can shop for a health insurance plan on the 
exchanges, they cut the advertising budget by 90 percent. They left 10 
percent there. I guess we are supposed to be happy with that.
  So they cut advertising by 90 percent. Then they started attacking 
the contracts for navigators. These are individuals all across the 
country who sit with people and say: Let me help you go through the 
options you might have for purchasing insurance or changing your 
insurance plan.
  For example, right now, we are in an open enrollment period, so folks 
can change their health insurance plans until Sunday--basically, 
December 15. It would be nice to have a navigator--an assistant, in a 
sense--sitting next to you if you are making those decisions about your 
healthcare.
  So threat No. 1 to healthcare is the lawsuit; threat No. 2 is the 
sabotage; and threat No. 3 has not quite played out yet, but I don't 
know a Member of the House or the Senate in the Republican caucus in 
either Chamber who is not against the threat--the cuts to Medicare and 
Medicaid proposed by the administration.
  I thought it was bad when the administration--or I should say, House 
Republicans--back in the spring of 2018 proposed a cut of $1 trillion 
to the Medicaid Program over 10 years. That was bad enough. That was 
dangerous enough. But the administration went further than that. The 
administration's proposal and, I have to say, unless it is 
contradicted, the official position of Republican Members of Congress 
is a 10-year cut to Medicaid of $1\1/2\ trillion--$1\1/2\ trillion. 
That means the official Republican position in Congress--unless they 
say they disagree with the President, and I haven't heard any Member 
say that yet--is that the Medicaid Program should be cut by $150 
billion each and every year for 10 years. That is the proposed cut. 
That is Medicaid.
  By the way, Medicaid is the kids' disabilities and nursing home 
program, for shorthand. Most of the people helped by Medicaid are folks 
in nursing homes, low-income children, children from low-income 
families, and children with disabilities who have a substantial stake 
in this.
  When you consider those three threats--the lawsuit, the sabotage, and 
the budget cuts--all are bad news, but then when you start getting into 
the details of each, you realize one aspect of this, which I wanted to 
raise today, and that is the adverse impact on children.
  We are told by the Georgetown University Health Policy Institute 
Center for Children and Families--I am holding up a November 2019 
summary of a report, a back and a front. I will not read all of it and 
I will not enter it into the Record because there is a lot of detail 
here that we probably can't enter into the Record. I do want to read 
into the Record a couple of highlights from it, though. These folks 
have been doing research on children's health insurance for many years 
and have spent their lives working on this. The headline reads ``The 
Number of Uninsured Children is on the Rise.''
  The United States of America, which finally, decades after passing 
the Medicaid Program, which was a great advancement in children's 
health insurance, then added to that with the enactment in the 1990s of 
the Children's Health Insurance Program--it had the letter ``S'' before 
it, the SCHIP program--which really was adopting programs that have 
been adopted in my home State of Pennsylvania and a few others.
  That same country which made a great advancement for children's 
health with Medicaid--tens of millions of kids--then made a greater 
advancement with the Children's Health Insurance Program and then made 
even more substantial gains when we passed the Patient Protection and 
Affordable Care Act and substantially drove down the number of 
uninsured Americans. Basically what happened was that about 20 million 
people got healthcare coverage in about 6 years--not even a decade. A 
number of those Americans were children.
  As we were substantially driving down the uninsured rate, what has 
happened in the last 2 years? The uninsured rate is going up. The 
Census Bureau told us in September that the uninsured rate is going up 
by 2 million people--to be exact, 1.9 million people. A big share of 
the 1.9 million people who are now uninsured--that number is going up 
instead of down, as it had been for most of the decade--a lot of those 
are children.
  Here is a summary of finding No. 1 in this report by the Georgetown 
University Health Policy Institute Center for Children and Families, 
November 2019. It is by Joan Alker and Lauren Roygardner. ``The number 
of uninsured children in the United States increased by more than 
400,000 between 2016 and 2018, bringing the total to over 4 million 
uninsured children in the nation.''
  That same Nation which made great advancements by lowering the number 
of uninsured children is now going in the wrong direction.
  Finding No. 2: ``These coverage losses are widespread, with 15 states 
showing statistically significant increases in the number and/or the 
rate of uninsured children.''
  The following States are listed: Alabama, Arizona, Florida, Georgia, 
Idaho, Illinois, Indiana, Missouri, Montana, North Carolina, Ohio, 
Tennessee, Texas, Utah, and West Virginia. That is significant. Those 
States are represented in some cases by two Democratic Senators, 
sometimes two Republican Senators, and sometimes Senators of both 
parties. So it is happening in a widespread fashion. The rate of 
uninsured children is going up.
  Finding No. 3: ``Loss of coverage is most pronounced for white 
children and Latino children (some of which may fall into both 
categories).''
  The other category where the number is going up substantially is 
younger children, under the age of 6. So we are not just talking about 
children losing coverage; we are talking about that number being more 
pronounced for children under the age of 6.
  This also includes children in low- to moderate-income families who 
earn between 138 percent and 250 percent of the poverty level, meaning 
a little more than 29,000 bucks to 53,000 bucks annually--``bucks'' is 
my word, not the report's word--$29,435 to $53,325 annually for a 
family of three. So these folks who are struggling in a lot of ways--
low-income families trying to climb that ladder to get to the middle 
class, in many cases working two or three jobs, trying to make ends 
meet--at least in many cases, their children had coverage, and now 
children in those families are losing coverage.
  Point No. 4 and the last point: ``States that have not expanded 
Medicaid to parents and other adults under the Affordable Care Act have 
seen increases in their rate of uninsured children three times as large 
as states that have,'' meaning States that expanded Medicaid. The 
expansion of Medicaid was part of that advancement I talked about.
  The three threats to healthcare are bad enough. It is especially bad 
when you consider that the Americans who are carrying the heaviest 
burden of that uninsured rate going up are, in fact, children.
  The second thing I want to raise is the Supplemental Nutrition 
Assistance Program. We had a great effort undertaken in the 2018 farm 
bill. There were

[[Page S6970]]

efforts by some to cut the Supplemental Nutrition Assistance Program, 
which we used to know as food stamps. Fortunately, those efforts to cut 
the program and to knock people off of the SNAP program were 
unsuccessful.
  We came together in a bipartisan effort in both the House and the 
Senate, and the President signed it into the law just about a year 
ago--December 2018. The ink was barely dry on his signature when his 
administration and the Department of Agriculture started to think of 
other ways to do the same thing to SNAP they couldn't do by way of 
legislation.
  So where are we? Well, we have had basically three proposals over the 
course of the last year by the administration that would take 4 million 
people out of the SNAP program, kick 4 million people off the program.
  Here is what one of those proposals would do: According to the U.S. 
Department of Agriculture's own estimates, the proposed changes to one 
part of SNAP called categorical eligibility would eliminate millions 
from the Supplemental Nutrition Assistance Program, and it could also 
leave nearly 1 million children without access to free school meals. I 
don't know about everyone here, but I think that is a step in the wrong 
direction.
  The Supplemental Nutrition Assistance Program is important not only 
for those families--many of them working families, many of them with a 
child in the household who needs food assistance, who faces food 
insecurity without SNAP--many of those same families might have a child 
and an individual with a disability in the same household or one or the 
other. That is the SNAP program.
  By the way, everyone else in the country benefits when people spend 
those SNAP dollars because when you provide those dollars and folks buy 
food, guess what happens. You guessed it. The economy gets a jump-start 
from that activity. The SNAP program isn't about just the people who 
are directly benefiting. I think we have an obligation to help them, 
for sure. We all benefit when there is economic activity. There is more 
than a bang for the buck in the SNAP program; you spend a buck, and you 
get a lot more than a buck in return.
  This is all in the context of where we are with a lot of families. We 
hear a lot on the floor of this Chamber and I am sure on the floor of 
the other body, the House, about ``Well, certain people shouldn't get 
this benefit,'' and some make an argument against that.
  It is interesting that in the SNAP program for many years now, not 
just for the last couple of years, the payment error rate in that 
program has been way down, the lowest levels ever. Why? It is because 
of good efforts to detect fraud, and also technology allows payments to 
be tracked. The payment error rate is at its lowest level ever. Yet we 
still have efforts undertaken to knock people out of the program. That 
is not just insulting, it is very dangerous to people's lives.
  I hope Members of the Senate will tell the administration to back off 
those proposals that have been undertaken to knock literally, if you 
have the effect of all three proposals, 4 million people off of the 
program, many of whom are children.
  This all happens in the context of those healthcare issues I raised 
before. The same child or the same family who might have their SNAP 
benefits cut or taken away might be the same family who is losing their 
coverage because of cuts to Medicaid and Medicare or because of the 
uninsured rate going way up in a country that was driving it way down. 
Both are happening at the same time.


                 Bipartisan American Miners Act of 2019

  Mr. President, I want to raise another issue, and then I will 
conclude. This is about coal miners across the country but in 
particular in a couple of States, like my home State of Pennsylvania, 
and I know this is true of Kentucky and Virginia and West Virginia, 
just to name several--or I should say the main States we are talking 
about here.
  The Bipartisan American Miners Act of 2019, S. 2788--I know Senator 
Manchin and others have spoken about this. We are trying to get this 
legislation or some version of this passed by the end of this year. I 
won't go through all the details of the legislation, but it attempts to 
help on the miners' pension issue--and these are obviously retired coal 
miners--as well as the healthcare for those same miners, those same 
families.
  I will make a comment about what this means. Many of those same 
families had to wait way too long--several years--before this body 
acted to provide a measure of relief to some of those retired miners on 
healthcare. The job isn't done yet on healthcare but even more so on 
pensions.
  The point I have always made here is that our government made a 
promise to them decades ago. In fact, it was the time when President 
Truman was in office in the late 1940s. We made a promise to coal 
miners at that time.
  In that whole intervening time period, those decades, they kept their 
promises. Many of them were sent overseas to fight in wars, from World 
War II, to Korea, to Vietnam and beyond. They kept their promise to the 
country by fighting for their country. They kept their promise to their 
employer by going to work every day in the most dangerous job in the 
world, likely. I am not sure there is one that is more dangerous. They 
kept their promise to their families to go to work and to support them, 
sometimes on that one income of a coal miner.
  In my home area of Northeastern Pennsylvania, the novelist Stephen 
Crane--he is known for the ``Red Badge of Courage,'' but what he is not 
known for as much is an essay he wrote about coal mining in the late 
1800s--1890s to be exact. He described all the ways a coal miner could 
die in a coal mine. He described the coal mine as a place of 
inscrutable darkness, a soundless place of tangible loneliness, and 
then walked through the ways a miner could die.
  I know we have advanced from the 1890s--thank God we have--but there 
are still coal miners in the recent history of this country who have 
lost their lives. All they have asked us to do--they haven't asked us 
to come up with some new fancy plan for them and their families; all 
they have asked us to do is to have this government--the executive 
branch and the legislative branch--keep the promise to coal miners and 
their families with regard to healthcare and pensions. Both of those 
parts of our policy are promises.
  So when we work on this between now and the end of the year to try to 
find a solution, we will be only meeting that basic obligation of 
keeping our promise to retired coal miners and their families like they 
kept their promise to their country.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Romney). The Senator from Kansas.