[Congressional Record Volume 169, Number 51 (Tuesday, March 21, 2023)]
[Senate]
[Pages S875-S880]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                          AFFORDABLE CARE ACT

  Mr. CASEY. Mr. President, I rise to talk about the Affordable Care 
Act, passed some 13 years ago, and in particular to talk about the 
Medicaid part of that, taking the Medicaid Program and allowing States 
to sign up for an expansion of Medicaid.
  But I thought the best place to start, as any healthcare discussion 
should start, is to talk about just one family. This happens to be a 
Pennsylvania family. I will start with two sisters. I will start with 
the older sister. Her name is Haley. Haley wrote me a letter just about 
2\1/2\ years ago now, talking about her little sister. Here is what 
Haley wrote to me. She talked about where her family lives in 
Pennsylvania, and then she said--her sister's name is Sienna--she said:

       My sister is my best friend. She has Down syndrome so 
     sometimes things are harder for her. It took her a long time 
     to walk and she is still learning to talk. Her therapists 
     help her and sometimes I help her too.

  Then she goes on to talk about how she, Haley, introduces her sister 
Sienna to her classmates. She said that she shares her sister with her 
friends, and I am quoting directly what Haley says:

       Mommy and me read a story at my school to explain Sienna's 
     muscles work different than ours. Our muscles are like rubber 
     bands but hers are more like play-doh. Now my friends 
     understand why things are harder for her and they all love 
     her. They think she is the cutest and so do I.

  So said an older sister about her younger sister.
  Of course, her mom wrote a much longer letter to me about what that 
family is facing every day. I won't go through all of it tonight, but 
when this family received that diagnosis of Down syndrome, Sienna's mom 
said:

       Sienna's diagnosis came as a surprise to us. After enduring 
     four miscarriages, she was our miracle baby. Our miracle baby 
     surprised us on the day of her birth with her diagnosis and a 
     heart condition. We were completely unprepared to raise a 
     child with a disability. After I delivered her, a kind nurse 
     explained to me how lucky we were to have Sienna here in 
     Pennsylvania after the passage of the Affordable Care Act.

  Then her mom goes on to describe all the benefits that she received 
because of the Affordable Care Act and because of her residence in 
Pennsylvania.
  That is what we are talking about here when we talk about healthcare. 
This isn't a budget question only. This isn't just a policy discussion. 
This is about real people's lives. And the further away you get from 
real people's lives, the easier it is to make the calculation, as some 
have made around here, some Members of Congress whose healthcare is 
made available to them because of the Federal Government--that is why 
they have healthcare, because of the Federal Government. Whether they 
are in the exchange or they have it some other way, most Members of the 
U.S. Senate and the House have that healthcare because of the Federal 
Government. So those with healthcare provided by the Federal Government 
seek relentlessly--too many seek relentlessly to use Federal power to 
cut people off of healthcare.

  This is about real people's lives, not something abstract, not some 
remote discussion about policy and about budgets and deficits and 
appropriations. This is about real people's lives, like Haley's little 
sister.
  I know there has been a lot of discussion of late about Social 
Security and Medicare and how we hope they are off the table, and that 
is good, those two earned benefit programs being off the table. But 
there is a third program that is not an earned benefit, but I would 
argue that Medicaid is--Medicaid tells us who we are as a nation. It is 
as if we look into a mirror when we consider the Medicaid Program, and 
it

[[Page S876]]

tells us what kind of a nation we are or what kind of a nation we will 
be if we slash it the way that so many people around here have proposed 
in budget after budget, year after year, talking about slashing 
Medicaid arbitrarily and outrageously and obnoxiously. We are going to 
stop them from doing it once again, but I think it is important to 
remind people what we are talking about here.
  Medicaid is a program basically about three Americans: children from 
low-income families--and not just in urban communities, but there are 
certainly a high number of children in our cities who benefit from 
Medicaid. Thank God we have the Medicaid Program all these decades 
later. The utilization rate is actually higher among rural children or 
children who live in rural communities. They have a higher utilization 
of Medicaid in the Children's Health Insurance Program than urban kids 
by percentage. That is a fact, and we need to remind people of that.
  Medicaid is a program that also helps people with disabilities. You 
can't march around here every day or year after year and say that you 
really care about people with disabilities, that you fight for people 
with disabilities, and then go and cut the Medicaid Program like some 
have proposed. And the proposals to cut it haven't just been in the 
tens of billions of dollars. That is just the annual cut they want to 
propose. It has often been hundreds of billions of dollars over the 10 
years within which we talk about budgets around here and 
appropriations--hundreds of billions of dollars in cuts. That is what 
some want to do.
  We have to remind ourselves again that this is a program about 
children and about people with disabilities. The third group of 
Americans, of course, is older Americans, our seniors. A lot of middle-
class families may not know it, but their mom or their dad or a loved 
one is in a nursing home solely because of Medicaid. You can't get into 
the nursing home, unless you can pay out of your own pocket, without 
the Medicaid Program.
  We could actually call the Medicaid Program the senior long-term care 
program or we could call it the program that provides healthcare to 
kids or we could call it the program that helps children with 
disabilities.
  Now we are told that the House Republican Study Committee fiscal year 
2023 budget plans to cut Medicaid, the Children's Health Insurance 
Program, and the Affordable Care Act--all three. They want to cut the 
Affordable Care Act marketplace subsidy spending by nearly half over 
the next decade.
  Again, when it comes to Medicaid, we are talking about a program that 
provides the funding for almost half of the births in America. So 
everyone who claims to care about children and babies and still wants 
to cut Medicaid has some explaining to do when you want to 
substantially cut a program that provides the funding for half of the 
births in the United States of America. It also provides almost half of 
the funding and support for long-term care services--services and 
supports, I should say--for older adults and people with disabilities. 
That is what the program is.
  This Republican Study Committee goes on to say their budget plan 
converts Medicaid to a block grant program where Federal funding would 
be capped and States would receive a fixed amount regardless of their 
actual costs.
  Here is what that means in real life: A State gets a block of money, 
a block grant, and when the State's costs go up for children or people 
with disabilities or seniors, and they hit the cap of that, those 
Americans are on their own. They are on their own because the State is 
out of money. That is what that means in the real world.
  But it gets worse. This plan also, thirdly, wants to cut the Federal 
so-called FMAP, the Federal medical assistance percentage, the 
percentage that the Federal Government pays for Medicaid. They want to 
cut that all the way down to 50 percent instead of the numbers that it 
has been at for years--so much higher. That is also a bad idea.
  So when we get back to this on what it means for families, we also 
have to consider what not just Sienna's sister said in her letter to 
me, but what about Sienna's mom, whom I quoted just a little bit a 
moment ago? Here is what Sienna's mom said:

       As I entered this new world--

  Because she just had a daughter diagnosed with Down syndrome.

       As I entered this new world of early intervention, 
     therapies, and medical needs, I began to realize just how 
     much of a financial toll this would take on us if it weren't 
     for the protections of the [Affordable Care Act] and 
     Medicaid.

  She goes on to describe that. She says:

       Sienna receives 7 weekly therapies. The costs of those 
     alone are $3,400 per week.

  That is $3,400 per week for those seven therapies.

       Without the ACA, her therapies and medical care would have 
     quickly exceeded the lifetime cap--

  Which was addressed in the ACA--

     and Sienna would be uninsurable for the rest of her life and 
     left without access to life saving care.

  Uninsurable. I can't tell you the number of times that has been in 
letters that I receive from parents worried about their child who has a 
disability in the United States of America, the most powerful country 
in the history of the world. These families are worried about their 
child with a disability not having access to services, not having 
access to those therapies, not having access to what they need to live 
their lives, and becoming ``uninsurable.'' That is an abomination. We 
are not the greatest country in the world if we do that. We are nowhere 
near the greatest country in the world if we do that. That would be a 
stain on America. Every one of us should be ashamed of that if that 
were to transpire. If that America transpired, it would diminish all of 
us. It doesn't matter what else we do around here if that happens.
  That is not the America that I think most people believe we are and 
should be, but some want to go there. I know they have all this talk 
about, oh, well, the cost of Medicaid is getting so great, and it is 
``unsustainable.'' That is Washington gobbledygook for people who do 
not have the guts, the political guts, to say: You know what, when you 
passed a tax bill in 2017 that gave away the store and so much else to 
big corporations for permanent corporate tax relief--and those same 
people who voted for that bill that gave permanent corporate tax relief 
to the biggest companies in the world, the biggest companies in the 
history of the world, are the same people who are saying: But we have 
to cut back on Medicaid because it is unsustainable. That is just 
throwing sand in the eyes of the people--that is what it is--blinding 
them with falsehoods. That is what that is. So we have work to do to 
prevent this from happening.

  Now, Mr. President, I am getting close to my time--and I am over 
already--but I wanted to make maybe two final points.
  We have had a concern, many of us, over the last number of years 
about access to Medicaid not being as stable as it should be; and that 
stability was enhanced by a provision called continuous coverage--that 
is the term of art, ``continuous coverage''--provisions that were 
enacted to ensure healthcare coverage during the COVID-19 pandemic.
  Across the country, Medicaid enrollment has increased since the 
beginning of the pandemic. For example, Pennsylvania's number went up 
to about 3.6 million people currently enrolled in Medicaid to keep 
their healthcare coverage uninterrupted.
  Over the last 3 years, States were prevented from disenrolling people 
with Medicaid. If not for the legislation passed in February of 2020, 
at the very beginning of the pandemic just before the CARES Act, people 
would have had to reapply for Medicaid on an annual basis.
  Studies have shown that this annual enrollment process can lead to 
unnecessary coverage losses due to administrative and procedural 
issues. This can be yet another barrier to ensuring that people with 
Medicaid continue to receive the coverage that they need.
  Now, here is the problem. Here is the challenge ahead of us. The 
appropriations bill passed in December set an end for the Medicaid 
``continuous coverage requirement'' because we are not in the pandemic 
anymore, and that was enacted during the pandemic; and that 
appropriations bill provided guidance to mitigate coverage losses as 
this requirement ends. So this kind of

[[Page S877]]

unwinding of some parts of Medicaid is set to begin April 1. States can 
start to disenroll people from Medicaid at the start of next month.
  So here comes our responsibility. Both parties in the Senate, both 
parties in the House--I should say, all three parties, Democrat, 
Republican, Independent--we have an obligation, a legal duty, a moral 
obligation that is inescapable to make sure that people know what they 
need to do to maintain that coverage. The Centers for Medicare and 
Medicaid Services are working with States to provide information, to 
promote continuous coverage, and, thirdly, to avoid inappropriate 
terminations as they begin to unwind this continuous coverage 
requirement.
  In Pennsylvania, the State I represent, the State is working 
diligently to clarify coverage in formats and languages accessible to 
enrollees to ensure that everyone understands their eligibility and can 
access the coverage that they are entitled to.
  My constituents are fortunate because Pennsylvania expanded Medicaid 
years ago, yet there are still States that have chosen not to expand 
Medicaid. We know that the expansion of Medicaid became easier with the 
passage of the American Rescue Plan. So we have to continue to 
encourage States to expand to make sure that more and more people get 
coverage.
  Let me end with this, Mr. President. As I outlined before, this is 
not just something nice to have. This is about life and death. It is 
about quality of life for families and for children, especially; but it 
is also about the risk of death if you don't have coverage. That is as 
true as any statement we could make, that this is about life and death.
  Here is what Sienna's mom--you heard from her sister, but here is 
what Sienna's mom said. And I will end with this. Towards the end of 
her letter, she said:

       I am proud to be Sienna's mom. This journey is full of 
     wonder, joy, and unimaginable love. It changes life's most 
     ordinary moments into the extraordinary. But with constant 
     attacks on our healthcare, it's also agonizing work, hard 
     decisions, and constant advocacy. It gets exhausting fighting 
     for your child, having to prove their value to the world.

  This is a mother talking about her child and having to live almost a 
separate life as an advocate because people in this town, year after 
year, are proposing cuts that would badly damage the life of her 
daughter Sienna.
  She goes on to say:

       Once again, we as parents are forced to suit up for battle 
     and prove that our children are worthy of healthcare.

  In America? Is that what we are asking parents to do? Parents who 
have had a reliance upon this program for years and, in some cases, 
decades and decades, we are asking them to suit up--again, as she said, 
``to suit up for battle,'' to make the case to Washington as to why 
they shouldn't cut the Medicaid Program in America? That is an insult 
to all of us.
  She shouldn't have to suit up for legislative or policy battles. She 
should have the opportunity to not worry about that and just to live 
her life and take care of her children and to live a life that she has 
been able to live with the help that we provided through Medicaid and 
other supports.
  So we have some work to do here, to stop--not to talk about and hold 
hands and compromise--to stop them from cutting what they want to cut 
in Medicaid at all costs. So that is what I am going to be doing. We 
are going to stop this from happening.
  We can compromise on a lot of things around here, but not on that--
not on cuts of hundreds of billions of dollars over 10 years to 
Medicaid. Not in this America.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from New Jersey
  Mr. BOOKER. Mr. President, I am grateful to the Presiding Officer for 
recognizing me.
  I want to say I am excited to be standing up tonight and talking, 
along with Senator Wyden, Senator Hassan, and we just heard from 
Senator Casey who is marking this 13th anniversary celebration with 
extraordinary determination not to see these great programs cut.
  I was not in Congress when the ACA was passed into law. But in an 
affirmation of that old adage about politics being local, I saw in my 
local community of Newark, NJ, the powerful difference that the ACA 
made, the difference that health reform had on my community.
  Folks would come up to me immediately in the months and years 
afterwards and talk about how they were finally able to get the 
healthcare that they needed, not only for themselves, but for their 
loved ones--how they moved from anxiety and fear to security and 
strength.

  You had folks with preexisting conditions who were discriminated 
against in the United States of America before the law's passage, but 
now they had a pathway for quality, affordable healthcare.
  Folks had to choose often between putting food on the table, paying 
rent, or just visiting a doctor; a choice between buying school 
supplies and getting their prescription drugs. Choices that, in this 
Nation--the richest Nation on the planet Earth--are outrageous, 
unacceptable, and fiscally irresponsible. What I saw as Newark's mayor 
is that, often, people would let their healthcare needs go until they 
ended up in the emergency room, which was a cost then borne by them and 
their family for unnecessary illness, but also to all of us. This 
should not be the Nation we live in, and we are celebrating the fact 
that 13 years ago this body made a difference.
  I have seen this passion for the Affordable Care Act echoed in my 9 
years as a U.S. Senator. One of my constituents told me, as a 
registered nurse from New Jersey, she spent her entire professional 
life caring for patients. Before the ACA, she witnessed those in need 
delay or simply refuse healthcare until it was too late. Soon, though, 
she almost became one of those patients herself after she retired and 
confronted her own health challenges and their accompanying costs. It 
was only thanks to the Affordable Care Act that she didn't have to 
resort to emptying her retirement accounts in order to afford the 
healthcare. She said it best herself:

       The Affordable Care Act saved my life.

  Another constituent of mine, a recent widow, wrote to me a few years 
ago. After losing her husband, she relied on the marketplace to get 
insurance--the Affordable Care Act marketplace. She was diabetic, had 
preexisting conditions, and told me:

       I'm afraid of having no coverage. I could lose my home and 
     everything I have saved during my 35-year marriage.

  Now, despite the partisan attacks that you hear against the 
Affordable Care Act, despite the challenges in the courts, we know the 
Affordable Care Act has worked. The data is clear. From 2010 to 2021, 
the number of uninsured, nonelderly individuals has decreased 
substantially in the United States of America from 46.5 million to 27.5 
million. That number has been nearly cut in half.
  We also know that the ACA has been invaluable in the fight to achieve 
just greater healthcare justice by dramatically decreasing the 
uninsured rate for many ethnic minorities in our country. For example, 
those rates have gone from 20 percent uninsured in 2010 to just 11 
percent in 2021; for Black folks, 33 percent to 19 percent; for Latino 
folks, 17 percent to 6 percent. We have seen a dramatic decrease for 
Asian Americans, Latino Americans, Black Americans, and more.
  The law has saved lives, unequivocally. A 2014 study showed that the 
ACA prevented an estimated 50,000 preventable patient deaths in just 3 
years from 2010 to 2013. And in the midst of the COVID-19 pandemic, the 
ACA marketplace was a lifeline to folks who were laid off and had no 
insurance.
  One of the most important things that this law has done is to get 
people insured, to reduce deaths, to lower healthcare costs, and to 
expand access to Medicaid to people who were previously ineligible.
  I live in a State that was one of the first to expand Medicaid to 
more of our citizens. We did it under a Republican Governor who 
recognized just how important it was that we expand Medicaid, how 
lifesaving it was, how good for the empowerment of families and 
children it was. It has helped so many more people in New Jersey obtain 
health insurance, and it has helped my State fight the opioid crisis by 
providing us the vital resources to do so.
  New Jersey is one of 39 States, plus the District of Columbia, that 
has chosen to expand Medicaid. By all accounts, these 39 States with 
Medicaid

[[Page S878]]

expansion are outperforming those who have inexplicably--you might say 
outrageously--chosen to reject Medicaid expansion, despite the 
overwhelming evidence that it helps countless Americans stay healthier 
and better access quality affordable care.
  Perhaps that is one reason why the State of North Carolina, with a 
Republican-led legislature and a Democratic Governor, are in the middle 
of a bipartisan process to expand Medicaid in their State, right now as 
we speak.
  States that expanded Medicaid have continuously shown to have lower 
uninsured rates, lower premiums on exchange policies, to have lower 
mortality rates. States that expanded Medicaid better live up to the 
ideals of this country that, fundamentally, we are about life--life--
liberty, and the pursuit of happiness.
  Expanding healthcare access lowers death rates. It is about life. 
Expanding healthcare access is about liberty, freeing people from fear 
and anxiety, from being chained to the worry that comes from not being 
able to afford even an ambulance ride. And, ultimately, it is about 
happiness.
  People in these States are going to the doctor more often for 
preventive screenings, visiting the dentist for dental care, getting 
mental health treatment. They have seen an increase in early stage 
cancer diagnosis when cancer is more treatable. People in those States 
have lower medical debt than in States that have neglected to expand 
Medicaid. It has actually had a positive effect on the overall economy. 
And I have led the charge to make sure that those States which expand 
Medicaid also provide coverage for birthing people, for moms, for a 
year postpartum.
  We live in a country that shamefully has a maternal mortality rate 
that is far higher than our peer nations and especially higher for 
marginalized communities.
  New data was recently released showing a significant increase in the 
maternal mortality rate in 2021. This problem is getting worse, with 
maternal mortality rates nearly doubling in the United States since 
2018. The maternal mortality rate is bad for all Americans, and it is 
even worse for African Americans.
  Given that Medicaid coverage covers half the births in the United 
States, the continuing expansion of coverage and care will help address 
these concerning trends and address those disparities and help ensure 
that more women can get access to the reproductive care that they need, 
and we could have more healthy births with healthy moms.
  The bottom line is clear: Medicaid is integral to helping Americans 
get the care they need and to affirm our common values.
  We love our children in this Nation, and the data for their births, 
for the children and their mothers, should reflect that love.
  What does love look like in public? It looks like justice. It looks 
like healthy children being born. It looks like lowering the death 
rates for women giving birth.
  Look, we have much work to do. We should note the progress on this 
13th anniversary. We should stop the politicization of healthcare in 
this country when we make strides that belie all the outrageous claims 
that were made about what the Affordable Care Act would turn into. All 
of the lies that were said about this legislation, all the dire 
predictions have not come true.
  Look, when I think about the ACA, I think back to the night I sat 
with my dear friend John Lewis, a hero to people on both sides of the 
aisle in this Chamber, a truly great American. When the Affordable Care 
Act was in crisis and threatened to be repealed, we sat on the Capitol 
steps, opened up Facebook Live, and started having a conversation.
  I will never forget. Hundreds of people came to join us on the steps 
of the Capitol, and I will never forget that John Lewis made it clear 
to this large crowd of people and to a live, online audience--he said:

       Affordable healthcare is the birthright of every American. 
     At stake are not just the details of policy but the character 
     [the character] of our country.

  Think about that for a second, the character of our country.
  Who are we? What do we stand for? Not just those unbelievable words 
on those founding documents, not just the spirit of America, but, in 
truth, you can judge the greatness of a country by the well-being of 
its people.
  I believe that when we talk about healthcare, we aren't just talking 
about policy and legislation and politics, but we are taking about the 
very fabric--the moral fabric--of this Nation. We cannot be a nation 
that stands for life, liberty, and the pursuit of happiness if people 
don't have access to what is fundamental to those ideals, which is 
quality healthcare.
  We are a nation that should be a beacon to the world. I believe we 
are. We are a nation of promise, a nation of hope, a nation of 
possibility, a nation of infinite potential. But there are still too 
many people in this country where that potential and that possibility 
are undermined by the mere fact that they cannot access a doctor, 
preventive care, birthing care. That is wrong.
  I am endlessly grateful for the Affordable Care Act for helping us to 
make a stride toward our ideals, for bending the arc of the moral 
universe more toward justice, for making this a more perfect union.
  Yes, tonight is a 13-year anniversary, but we should commit ourselves 
to going from doing good work, from making progress, to ultimately 
doing what we are called to be, which is a nation that is a light unto 
all nations. It sets the highest standards for healthcare and health 
outcomes; that we are not a nation that proclaims a nation of life, 
liberty, and the pursuit of happiness but demonstrates it relative to 
all other nations in the true fabric of our living. That is a cause 
that calls this body and the House of Representatives and our Federal 
Government that should call us not just to celebrate a 13-year 
anniversary but to continue to improve upon the good work that was 
done.
  I am concluded with my remarks. I am just a warmup act for the 
Senator who is coming right now, from my second favorite ``new'' State 
after New Jersey, the great State of New Hampshire.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from New Hampshire.
  Ms. HASSAN. Well, Mr. President, thank you to my colleague Senator 
Booker for that kind introduction and as important, if not more, for 
his great comments about the importance of the Affordable Care Act to 
our constituents, to our communities, to our State, to our country, to 
the cause of human dignity.
  I rise today to join my colleagues in commemorating the passage of 
the Affordable Care Act 13 years ago. I am so grateful to be here not 
only with Senator Booker but Senator Wyden and Senator Casey and 
grateful for their advocacy and their efforts to really help people 
understand the difference that this law has made for the people of our 
country.
  I want to take a moment to discuss the difference that this law has 
made for the people in New Hampshire. I also want to build on what 
Senator Booker just talked about by talking about the growing 
bipartisan support for Medicaid expansion and how that shows just how 
much we can accomplish when we put politics aside and we work together. 
It also shows the urgent need that we have for remaining States to 
follow New Hampshire's bipartisan example and adopt Medicaid expansion.
  The Affordable Care Act, and Medicaid expansion in particular, has 
done more to improve the health of the people of our country than any 
law passed in the last 50 years. This law was based on a simple 
proposition that when everyone has access to quality, affordable care, 
our country is stronger and our people are more free.
  Our people are more free because, as the adage goes, when you have 
your health, you have everything.
  We do not fully appreciate these words until we or someone we love 
falls ill. Facing health challenges is never easy, but it is easy to 
forget how much more daunting they used to be before the Affordable 
Care Act.
  Thanks to the Affordable Care Act, millions of Americans now have the 
freedom and peace of mind of knowing that they will not be denied 
access to affordable healthcare, even if they lose their job or have a 
preexisting condition. For too long, many Americans had to pay 
painfully high premiums or were even denied coverage altogether just 
because they had a preexisting

[[Page S879]]

condition. These conditions range from diseases like cancer and 
diabetes to pregnancy or asthma. Often, people with these conditions 
are the very people who need care the most.

  No matter your political party, all of us should be united in 
celebrating that the days of denying someone coverage on account of a 
preexisting condition have ended.
  Granite Staters know the difference that the Affordable Care Act has 
made. As Governor, I led the effort to get Medicaid expansion done, 
signing it into law in March of 2014. Only a handful of months later, 
the plan was implemented, thanks to extraordinary work by the employees 
of our State's Department of Health and Human Services.
  Medicaid expansion has made an incredible difference for tens of 
thousands of Granite Staters. Medicaid expansion has made our people 
healthier and our workforce stronger. Since 2014, the uninsured rate in 
New Hampshire fell by over 40 percent. More than 200,000 Granite 
Staters have participated in expanded Medicaid.
  All of us in this Chamber have entered public service with the hope 
that we will help our communities and our country. Make no mistake, 
behind these statistics, and similar statistics for other States, are 
countless stories of people whose lives were transformed or even saved 
by the law.
  For many, it made their families more financially secure. For others, 
it allowed them to address longstanding health challenges that 
prevented them from participating in the workforce.
  I want to share one of these stories. The Affordable Care Act has 
made a great difference for people struggling with addiction and 
substance misuse. Some may not know this, but in many States, Medicaid 
expansion marked the first time that substance misuse treatment was 
covered by Medicaid. This is particularly important for a State like 
New Hampshire, which has been hit hard by the substance misuse crisis.
  Whenever I talk about expanding Medicaid, one of the first people I 
think of is a woman I met in Manchester named Ashley. For nearly a 
decade, Ashley struggled with heroin addiction. At one point, she was 
arrested, and eventually her then-husband overdosed, but that was not 
the end of Ashley's story.
  In 2016, she became one of the tens of thousands of Granite Staters 
who have received substance misuse or mental health treatment covered 
by New Hampshire's Medicaid expansion. She went into recovery, found 
work, and has rebuilt her life. Ashley now works for a recovery 
community organization, helping others get the help and support that 
they need. None of this would have been possible without Ashley's 
strength and perseverance or if we failed to expand Medicaid.
  Ashley's story is a reminder of why Medicaid expansion matters for so 
many Americans. It has helped countless people get the care that they 
need to be healthy, have a job, and participate in their communities.
  The benefits of expanded Medicaid for people like Ashley is, in part, 
why Medicaid expansion has gained bipartisan support over the last 
decade. Even when partisan politicians have been slow to act, voters 
from both parties have come together and pushed Medicaid expansion 
forward.
  Just last November, voters in South Dakota voted to expand Medicaid. 
They were the latest in a long line of Republican-led States whose 
voters went to the polls and passed Medicaid expansion, including 
Nebraska, Oklahoma, Idaho, and Utah. These ballot initiatives only 
passed because voters from both parties stood together, and we can 
learn from their example.
  This growing bipartisan consensus is an example of our capacity to 
solve problems when we work together. This has certainly been true in 
my own State.
  It was not that long ago that Medicaid expansion was at the center of 
our most polarizing, partisan debates. I know because I was in the 
middle of them as Governor. The debates were long, and the negotiations 
tough, with a divided State legislature. But, ultimately, we adopted 
bipartisan Medicaid expansion in New Hampshire. By listening to each 
other and finding ways to work together, we were able to put people's 
health ahead of politics and get it done.
  Just recently, the New Hampshire Republican-controlled State Senate 
voted unanimously to support reauthorizing the expanded Medicaid 
Program. What was once a political lightning rod is now an essential 
part of our public healthcare system.
  It has also strengthened both our economy and our workforce. Workers 
are more secure in seeking new and better jobs, knowing that if they 
have to switch insurance plans, they will not be denied coverage on 
account of a preexisting condition.
  And people who couldn't get healthcare for a medical condition and, 
in turn, couldn't work because of their condition, can now get health 
insurance, get the treatment that they need, and join the workforce.
  In short, this law has become a fundamental part of our State's 
promise to do right by Granite Staters.
  New Hampshire's bipartisan Medicaid expansion as well as the 
bipartisan efforts in other States are an important reminder of what we 
can accomplish when we work together. When we take the politics out of 
an issue, when we care more about whether an idea is good rather than 
whether it is red or blue, we can accomplish tremendous things. We can 
make our country a better place because, ultimately, the Affordable 
Care Act was nothing less than a step forward for the cause of human 
dignity and freedom.
  To be sure, there is much more work we need to do to improve the 
quality and affordability of healthcare, and I welcome my colleagues to 
join me in bipartisan efforts to do just that.
  Having listened to my colleague Senator Casey just a few minutes ago, 
I want to note my agreement with him that cutting Medicaid or repealing 
the Affordable Care Act are not measures that will meet that goal.
  I also urge Governors and legislators in the remaining States that 
have not expanded Medicaid to follow the bipartisan example that New 
Hampshire and other States have set. Look at the difference it has made 
in my State and in States across the country. This is an effort that 
has the support of majorities in both parties and should unite all 
Americans.

  Thank you to everyone in this body and in legislatures across the 
country who made the Affordable Care Act and Medicaid expansion a 
reality. I sincerely hope that we bring the same bipartisan commitment 
that Medicaid expansion enjoys now to tackle future challenges, because 
today is a reminder that, when we leave partisan debates in the past 
and find ways to work together, we can build a country that is stronger 
and more free.
  With that, Mr. President, I am very proud and grateful to yield the 
floor to my colleague Senator Wyden, who has been such an extraordinary 
leader in improving and expanding access to healthcare and dignity for 
all Americans. Thank you.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. WYDEN. Mr. President, before the Senator leaves the floor, I just 
want everyone to note that what the Senate just heard was Senator 
Hassan--vintage Senator Hassan--saying repeatedly: Let us find a way to 
move forward in a bipartisan way. And through example after example, 
she cited the progress. It has always been that, even before the 
Affordable Care Act.
  I was the author of the Healthy Americans Act, the first bipartisan 
universal coverage bill in the history of the Senate--14 Senators, 7 
Democrats and 7 Republicans--because we learned the lesson Senator 
Hassan has described and took it into the Affordable Care Act. So I 
thank my colleague for her wonderful remarks. And for people who are 
paying attention, this is what we get in the Senate Finance Committee 
every single time Senator Hassan is in the house.
  Mr. President, the landscape of American healthcare is shifting 
dramatically in the 13 years since the Affordable Care Act was signed 
into law.
  I believe many find it hard to even recall the day when an American 
could be denied health insurance because of preexisting medical 
conditions, but we ought to remember the history. Those were the days 
when healthcare was for the healthy and the wealthy. The insurance 
companies, under the law, could just clobber--clobber--somebody

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with a preexisting condition. You were basically on your own.
  And, apropos of the implications to the economy, I have talked to the 
President of the Senate often about encouraging innovation enterprise. 
When we discriminated against people with preexisting conditions, the 
big problem we saw was job loss. When somebody had the opportunity to 
be mobile and to move somewhere else, they weren't able to do it 
because they were tethered to their position because they had coverage, 
and they couldn't get it if they moved on. Now, tens of millions of 
Americans have health and financial security thanks to 39 States--39 
States--that have moved beyond just ending the discrimination against 
those with preexisting conditions to expanding Medicaid coverage.
  The Affordable Care Act was also, we should remember, passed in a 
moment of great need. The recession--the great recession--caused 
massive economic damage and layoffs across the country. Millions lost 
the employer-provided health insurance they had. More than 50 million 
Americans lacked any form of health insurance coverage, and there was 
no backstop for them.
  At that time, you basically were literally on your own. If you were 
sick and you were faced with providing for your family, you could lose 
virtually everything in those tragic kind of days when people didn't 
realize the importance of the changes that needed to be made.
  It is now clear, for example, how important the Medicaid safety net 
truly is. The number of uninsured Americans has been cut in half. In 
addition to Medicaid, the individual marketplace hit record enrollment 
with 16 million people buying plans. In Oregon, that amounts to 140,000 
Oregonians getting high quality, affordable health insurance. This was 
particularly obvious when the pandemic hit in 2020. Not only was the 
individual marketplace there to help the millions who lost their jobs, 
but Medicaid was the lifeline to help families get healthcare.
  By the way, it is clear now that Medicaid can be a leader when it 
comes to innovative healthcare. I was particularly proud that in the 
rescue plan in 2021, we were able to bring together, for the first 
time, mental health leaders and law enforcement leaders to develop a 
multidisciplinary system with mental health and law enforcement to 
provide crisis services when someone on the streets of this country is 
struggling.
  At the end of last year, the Congress passed a nationwide--
nationwide--guarantee of a full year of continuous health coverage for 
kids up to 19 years of age who were enrolled in Medicaid and a 
permanent option for States to provide a full year of postpartum 
coverage for new moms. I am proud that Oregon pioneered this continuous 
coverage policy for kids before it was adopted nationwide.
  It is just commonsense that kids need reliable health coverage even 
if their parents' income is changing from month to month, and all of 
the research--all of the healthcare research about brain development--
makes that very clear.
  We understand that there is a lot more to do. Tomorrow, we will hear 
from the administration in the Senate Finance Committee about some of 
the next steps. The Affordable Care Act moved forward significantly to 
resolve the crisis of health coverage, but there are still gaps.
  I also mention that, for a lot of us, we now recognize that it is not 
just a question of expanding coverage. It is a question of controlling 
costs, and we are going to be focusing on that in the days ahead as 
well. Elected officials are often pretty good talking about expanding 
coverage, but not so good at controlling costs.
  With respect to that, the Inflation Reduction Act made a significant 
down payment on cost containment by finally lifting that Holy Grail 
guarded zealously by Pharma--the prohibition on negotiating. Now 
Medicare can negotiate lower drug prices and implement what we wrote in 
the Senate Finance Committee in 2019--the price-gouging penalty. In 
2019, with bipartisan support in the Finance Committee, we said, if Big 
Pharma raises prices faster than inflation, there is finally 
accountability for high pharmaceutical prices, and they are going to 
pay penalties.
  Improvements to the affordable healthcare system is still in 
progress. Last week, the North Carolina State Senate passed a Medicaid 
expansion bill by an astounding 44-to-2 margin. That is a very obvious 
indication that, as Senator Hassan talked about and Senator Casey, 
there could be bipartisan support here. Medicaid expansion saves lives. 
It is a good deal for States, and it is wonderful to see States across 
the political spectrum following the example of North Carolina.
  Finally, we took additional steps recently to help improve our 
coverage, particularly with the advanced premium tax credit, increasing 
the amount of financial help for middle-class families trying to 
balance health expenses against food, rent, and other costs. It also 
expanded eligibility for these tax credits for more middle-class 
Americans. The President's budget supports making these kinds of 
enhancements in coverage permanent and so do I.
  I will close with this. One of the dividing lines in American 
Government is whether you think healthcare is a basic human right. My 
experience, having specialized in this for a lot of years, since the 
days when I was director of the Gray Panthers, is that there are a 
variety of ways you can get there. And that is what we do in the 
Congress. We debate ideas. But I feel right to the core of my time in 
public service and those days with the Gray Panthers that healthcare is 
a basic human right. The Affordable Care Act was a monumental step 
toward that long sought goal, and, as long as I have the honor and the 
privilege to chair the Senate Finance Committee, I will do everything I 
possibly can to work with Senators of both political parties to make 
that crucial goal a reality.
  I yield the floor.

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