[Congressional Record Volume 166, Number 178 (Monday, October 19, 2020)]
[Senate]
[Pages S6322-S6323]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                    Nomination of Amy Coney Barrett

  Mr. CASEY. Mr. President, I want to start tonight by just making a 
few remarks regarding what is ahead of us in the next few days, and 
that is the debate about a Supreme Court Justice. I won't be able to 
cover everything tonight that I want to cover, but I will just make 
some preliminary comments about healthcare, which has been the driving 
debate in this nomination or at least the issue that has dominated the 
debate so far.
  We made, in my judgment, great progress in 2010, when the Patient 
Protection and Affordable Care Act was passed. Some refer to that 
statute as ObamaCare, which isn't really the name of the statute and 
doesn't adequately describe what it is about. The patient protection 
part of the act--or the name of the statute--is the part that I think 
involves most Americans, all the coverages that are provided, all the 
protections, I should say, that are provided. One example of that, of 
course, is the protection for preexisting conditions. The state of the 
law prior to that was if an insurance company did not want to cover 
someone because of a preexisting condition, they had the authority to 
do that or they could cover the person but charge them more. That is no 
longer permitted, and in a State like Pennsylvania, that number--the 
number of people who are protected by that provision of the law because 
they have a preexisting condition--that number is 5.5 million people. 
Nationally, it is as high as 135 million. So we know what is at stake 
in the debate, and it just so happens in this context that it is part 
of the debate about the Supreme Court nominee, Judge Barrett.
  I have a threshold, initial concern that is even before we get to the 
debate about the Affordable Care Act and what might happen to it by 
virtue of the lawsuit filed that is now before the Court with an 
argument date of November 10. I think that is the primary reason for 
the rush of her nomination--so that she can be a member of the Court 
for that argument on November 10 and make that decision, which I think 
is highly likely to be a decision against upholding the 
constitutionality of the Patient Protection and Affordable Care Act.
  The threshold concern I have, though, is just the way this process 
has unfolded, not just more recently but over time. The President, when 
he was a candidate, said he would choose from a list that was developed 
basically by

[[Page S6323]]

two groups: the Federalist Society and the Heritage Foundation. They 
came up with a list, and that is the list he said he would choose from. 
That list was expanded when he became President.
  Judge Barrett was on that list, Justice Kavanaugh, Justice Gorsuch--
you can see the pattern there. I don't want a Supreme Court that is 
chosen by those two groups, but, so far, that is what the President has 
decided to do.
  In this case, the rush is, I think, for that basic reason, that the 
majority party here and Republicans in the House and a Republican 
President want this statute struck down. They want to have that 
majority, a six-to-three majority, to do that.
  But I guess, as much as I can talk, as we all do, about some of the 
policy--and I will--and the numbers, I think the most compelling parts 
of this debate are the stories that come from people across 
Pennsylvania and across the country who have come to us. I met some of 
these families about 10 years ago when we were debating the act then. I 
met them again when we were trying to stop the repeal in 2017 and 2018, 
and now we are getting together again because of this new and, I think, 
mortal threat to the law.
  I will just mention two for tonight--Erin and Shannon. Erin, I know 
better; I have met her over the years--Erin Gabriel. She has been very 
public about the fight that she is waging on behalf of her three 
children with disabilities: Collin, Bridget, and Abby. I have heard a 
good bit about each of them and maybe the most about Abby.
  Erin is from Beaver County, PA, right on the Ohio border, just north 
of Pittsburgh, and she is very concerned about what happens to her 
children because of their disabilities. Of course, under the old law--
the old way of approaching these issues--a child with a disability 
could be denied coverage because of a preexisting condition, and, also, 
a corresponding or related concern is the threat to Medicaid itself, 
especially in budget debates here over time, and Medicaid expansion.
  Erin Gabriel is one of the people who has made very clear to us the 
adverse impact on the life of her children that could result if the 
statute is overturned and declared unconstitutional.
  A second person who has brought her story to our attention is Shannon 
Striner. Shannon is a mom to two daughters: Haley and Sienna. Haley is 
actually a second grader now, and Sienna is a young girl with Down 
syndrome. Obviously, Sienna is a child who is going to need a lot of 
care, and we have to make sure that our healthcare system is there to 
meet the needs of those families.
  We are going to be talking more about these challenges that these 
families face, but for the life of me, I will never be able to 
understand--if I lived 1,000 years, I will never be able to understand 
why we would ever go backward on healthcare. Why would we go back to a 
time when a child or an adult who has a preexisting condition would be 
denied coverage? Why would we go back and erase by virtue of, in this 
case, what would be a judicial fiat all the progress that has been made 
because of the Affordable Care Act?
  So many more people have the security of healthcare. In my home 
State, it is 1 million people who gained coverage. The number now 
nationally is about 23 million. That number keeps going up. Most of 
them are getting their healthcare through the expansion of Medicaid. 
The number on that keeps growing.
  Part of the reason it is growing is because people lost their 
insurance as a result of the adverse impact of COVID-19--people losing 
their jobs and turning to programs like Medicaid for coverage. So that 
number keeps going up.
  In the State of Pennsylvania, just by way of example, the latest 
number is 840,781 Pennsylvanians who have benefited from Medicaid 
expansion. The benefit of it is one of the reasons you have States that 
are not controlled by Democrats that are voting to expand coverage. So 
that number keeps going up.
  I want to make sure that we take every step necessary to protect 
coverage, not just to uphold a statute and to, frankly, grow the number 
of people with healthcare but to remember the impact it has on people's 
lives and ensure that the people who gain coverage don't lose it.
  We have a State--as the Presiding Officer knows because of his 
family's roots--we have a State of a few big cities, but mostly it is a 
State of a lot of small towns. We have 48 rural counties out of 67, and 
in those small towns or rural communities, we have a lot of people who 
have gained coverage because of the expansion of Medicaid.
  As I said, you can see the number: 840,000 out of about 1 million who 
gained coverage--gained coverage through Medicaid expansion, so that is 
a big number. And even in a small county like Cameron County, one of 
our smallest--it might be the smallest county in population--there are 
350 people in that county who got Medicaid expansion. I want to make 
sure all 350 or more can benefit from Medicaid expansion.
  Big cities like Philadelphia have bigger numbers, obviously. When I 
look at my home county, Lackawanna County, and look at the next county 
next to it, the largest population county in the region, Luzerne 
County, these are huge numbers of people who have gained coverage on 
Medicaid expansion. In Lackawanna, it is more than 17,180 people and 
more than 26,000 in Luzerne County. Now, that is not accounting for the 
folks who got coverage because of the exchanges that were set up. So 
the balance of those folks in Pennsylvania who got coverage, between 
840 and 1 million, got their coverage because of the exchanges that 
were set up by the Affordable Care Act.
  One last point before I move to a second topic: Here are some of the 
benefits of Medicaid expansion that don't get a lot of attention but 
should warrant attention. I will just give you one example in 1 year 
from one State.

  In 2019, in Pennsylvania, over 135,000 people were able to receive 
treatment for substance use disorder because they were covered through 
Medicaid expansion. Now, most people may not think of that longer 
category or that long phrase, ``substance use disorder,'' but a 
subcategory to that and one of the largest parts of that challenge for 
many families and many communities is the opioid crisis. So that means 
tens of thousands of Pennsylvanians were getting covered by Medicaid 
expansion and treatment therefrom just at the time the opioid crisis 
was on the rise and causing death and devastation to so many families 
and so many communities. So that is one benefit to the program that 
doesn't get a lot of attention.
  We know that on the larger question of the Affordable Care Act 
itself, beyond Medicaid expansion and the exchanges, is the so-called 
prescription drug doughnut hole, that coverage gap where the older 
Pennsylvanian, at some point in the availability of prescription 
medications, has to pay for a while before they get into a catastrophic 
category where the Federal Government and the Medicare Program can pick 
up the cost. But in that coverage gap--and ``doughnut hole'' is a very 
benign way of describing a very burdensome problem for a lot of 
seniors--if that were to go away, if the Affordable Care Act were 
declared unconstitutional and that doughnut hole coverage or the 
filling of the gap, so to speak, were not there the next year or the 
year after or 5 years or 10 years from now, that could adversely impact 
hundreds of thousands of Pennsylvanians. By one estimate, more than 
293,000 people on Medicare would be forced to pay more for their 
prescription drugs.
  So that is a lot on the line when it comes to the Affordable Care 
Act, and that is why this nomination is of such great consequence for 
one big issue. I think the Affordable Care Act Supreme Court decision 
will be the most significant decision that this Court will decide maybe 
for 25 years because of the scope of the impact.
  Even someone who is not threatened directly by the loss of coverage, 
the loss of protection for a preexisting condition, or even someone who 
can buy because of their wealth or their circumstances--that person 
will also be affected because premiums will likely skyrocket. So there 
are very few, if any, Americans not affected by this lawsuit that will 
utterly destroy the Affordable Care Act.