[Congressional Record Volume 169, Number 81 (Monday, May 15, 2023)]
[Senate]
[Pages S1642-S1645]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                              Debt Ceiling

  Mr. WYDEN. Mr. President, as chairman of the Senate Finance 
Committee, I am pleased to be joining my colleagues on the Senate floor 
today to discuss the importance of Medicaid to American families.
  Right now, Republicans in the House of Representatives are pushing a 
scheme that threatens Medicaid coverage for over 20 million Americans.
  Over the course of the evening, my colleagues on the Senate Finance 
Committee and I will make clear why this is a bad deal for all 
Americans. Democrats in the Senate won't stand for it.
  Now I am going to turn it over to Senator Casey for his remarks, and 
I believe we will have other Senators from the Finance Committee coming 
next. And I will wrap it up.
  Senator Casey.
  The PRESIDING OFFICER. The Senator from Pennsylvania.
  Mr. CASEY. Mr. President, I want to start by thanking Chairman Wyden 
for his leadership on a range of issues that are important to 
vulnerable Americans, Medicaid being in the lead of that.
  Over and over again, Chairman Wyden has led us to ensure that we 
don't provide the kind of cuts that have been proposed in this debate 
about the next steps on ensuring that America doesn't default. And 
there is no question that not just people on both sides of the aisle 
but the American people want us to ensure that we do not default.
  The consequences of default--I won't itemize them. I think Americans 
are well familiar with them, but the consequences of default in a word 
would be ``catastrophic'' for every family, for every community in the 
country, and the consequences are too numerous to cite for tonight's 
purposes.
  But here is the problem: Even as most Americans want to take default 
off the table--most Members of Congress do--there are still some 
Members of the House, House Republicans, who want to keep default on 
the table or, in order to agree with the consensus, their pathway to 
avoiding default is to cut and cut and cut and decimate programs that 
are important to vulnerable Americans.
  They would cut tens of billions, for example, from the Supplemental 
Nutrition Assistance Program, and the TANF Program, the Temporary 
Assistance for Needy Families Program, and the Children's Health 
Insurance Program. There are tens of billions just in those programs 
alone.
  And then, as Chairman Wyden made reference to, Medicaid. The proposed 
cuts by House Republicans would devastate so many Americans who rely 
upon Medicaid: children, seniors, people with disabilities.
  It would also, at the same time, not just be cuts of millions or tens 
of millions, it would be a $100 billion cut to Medicaid over 10 years. 
That is the proposal. That is what we are supposed to accept as the 
only pathway, the only pathway to avoiding default.
  Everyone knows that is a lie. Everyone knows that that is throwing 
sand in the eyes of the people so that they can't see the truth right 
in front of them. We must reject any bill that will increase poverty 
and take away healthcare from Americans.
  What is Medicaid? I think we found out a lot more about what that 
program means to so many Americans over the last 10 years, when there 
were proposals over and over again to cut by 10 billion a year or 20 
billion or 50 billion a year, proposed by House Republicans over and 
over again.
  Medicaid tells us who we are as a people, as a country. It also tells 
us whom--whom--we value. We value our children, whether they live in 
rural areas or small towns or in cities or suburban communities. We 
value those children. And that is what Medicaid is all about, making 
sure those children have healthcare.
  We value people with disabilities. We say to ourselves as a people, 
we have to help folks who have a disability so they can lead a full 
life. Medicaid does that by providing healthcare to people with 
disabilities, especially children with disabilities. We found that out 
in a very real way when we were debating the proposal right here on the 
Senate floor in the summer of 2017.
  When some said we should get rid of the Patient Protection and 
Affordable Care Act, the consequence of that, of course, was to 
devastate children on Medicaid who have disabilities.
  Thirdly, of course, Medicaid tells us who we are because it protects 
seniors; it provides healthcare for seniors; it allows seniors to have 
long-term care. Now the same crowd, Members of Congress, who were 
proposing cutting Medicaid by $100 billion over the 10 years, that is 
the same crowd who voted on a tax bill in 2017. Right around 
Christmastime, in December of 2017, they voted and passed a tax bill 
that gave away the store to very wealthy Americans and big 
corporations.
  Now, they didn't have any compunction then about revenue. They said: 
We have got plenty of revenue so we are going to cut taxes for wealthy 
people and big corporations.
  Now they come to us and say: Oh, we need to make cuts. We need to 
make cuts, and the cuts go to programs that help the most vulnerable.
  Here is what Medicaid does for three groups of Americans: It makes it 
possible for one-third of all women in the United States of America to 
receive consistent, comprehensive prenatal care to increase the 
likelihood of having a healthy baby born at full term.
  The House Republican bill puts one-third of pregnant women at risk of 
losing--losing--prenatal care. Here is what it means for Pennsylvanian 
families, women, and their children: About 43,700 births in the State 
of Pennsylvania each year are paid for by Medicaid, covered by the 
Medicaid Program. So that is one-third of Pennsylvanians or Americans 
who happen to be women who are pregnant.
  Second, Medicaid provides healthcare and services for about half--
about 45 percent--of all the adults in the country with disabilities. 
That is 10 million people in America who are benefited directly by the 
Medicaid Program.
  The House Republican bill would expand the waiting list for home- and 
community-based services for seniors and people with disabilities. That 
is what they would do, make that waiting list, which is intolerably too 
long right now, make that longer.
  Third, Medicaid pays for two-thirds of all long-term care for older 
adults who need nursing home or home care services. Again, the 
Republican House bill would cut funds for two-thirds of

[[Page S1643]]

older adults who live in nursing homes or in their own homes with 
support.
  What does that mean for Pennsylvanians? About 63 percent of nursing 
home residents use Medicaid as their primary payor. They couldn't get 
into a nursing home. They would not have long-term care absent the 
Medicaid Program, but House Republicans want to cut that program.

  In our State, nearly 3.7 million people rely upon either the Medicaid 
Program or the Children's Health Insurance Program, 3.7 million 
Pennsylvanians, and yet even some Members of the Pennsylvania 
delegation in the House want to cut the Medicaid Program.
  The Republican bill passed by the House would put a million 
Pennsylvanians at risk of losing Medicaid immediately--1 million 
Pennsylvanians. So let's take default off the table. Yes, take it off 
the table.
  But let's also take off the table cuts to Medicaid, cuts to the SNAP 
program, the Temporary Assistance for Needy Families Program, as well 
as the Children's Health Insurance Program.
  These programs, and especially for purposes of tonight's focus on 
Medicaid, tell us who we are as a country and whom we value. I think we 
can do better than what has been proposed on the House side.
  We can avoid default and make sure we are meeting our obligations, 
not just to the Nation, in terms of our economy, but meeting our 
obligations to our families, the most vulnerable families in our 
Commonwealth and in our country.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Oregon.
  Mr. WYDEN. We are going to recognize next our distinguished colleague 
from Massachusetts. I just want to say, Senator Casey has made, as is 
usually the case, an eloquent argument that preventing default and 
standing up for the most vulnerable people, those two are not mutually 
exclusive. You can do both.
  And Senator Casey's arguments, as is usually the case in our Senate 
Finance Committee, really strike home to this Senator. And I want to 
thank him for day in and day out talking common sense and making it 
clear that default is unacceptable and harming so many vulnerable 
Americans, in Pennsylvania, Oregon, Massachusetts, and elsewhere, is 
also unacceptable. And I thank my friend.
  And we have another passionate advocate for people who are vulnerable 
from the Senate Finance Committee, our friend from Massachusetts 
Senator Warren.
  The PRESIDING OFFICER. The Senator from Massachusetts.
  Ms. WARREN. Mr. President, I want to say a very special thank-you to 
Chairman Wyden for coming here tonight to talk about the consequences 
of default. Our whole Nation needs to tune in and pay attention to this 
because this is literally about the future of our country.
  Kevin McCarthy and House Republicans are holding America's economy 
hostage. Even worse, the Republicans are holding America's good name 
around the world and America's promise that we pay our debts hostage.
  Instead of passing an increase in the debt ceiling, Republicans have 
put forward a set of incredibly damaging proposals that would hurt 
families around the country, proposals that are so unpopular that the 
only way that Republicans could possibly pass these proposals is to 
threaten to derail the entire economy if they don't get their way.
  Now, let's be clear. Kevin McCarthy is the only one who will not take 
default off the table. Joe Biden has said no default. Chuck Schumer has 
said no default. Hakeem Jeffries has said no default. Even Mitch 
McConnell has said no default. But Kevin McCarthy is still driving this 
Nation toward default.
  Now, every aspect of the House Republican proposal is deeply harmful, 
but I am here today to talk about three of the most wrongheaded 
provisions in their plan: the threat to take away health coverage for 
more than 21 million Americans; the threat to take away food assistance 
from 1 million people struggling with hunger; and the threat to take 
away income assistance for our poorest families.
  Republicans' assault on Medicaid, SNAP, and TANF is no surprise. For 
years, Republicans have worked to undermine these programs which 
protect the most vulnerable Americans.
  People enrolled in these programs are already walking a tightrope to 
make ends meet. Now Republicans want to use an old trick to make it 
even harder by trapping applicants in a maze of burdensome and 
unnecessary paperwork.
  Republicans call these rules ``work requirements.'' I call them 
``unworkable requirements.'' We need to call these proposals for what 
they are: a bald effort to kick people off the programs they need to 
survive.
  The unspoken Republican mantra is: Let them get sick. Let them 
starve. And let them live on the streets with no hope.
  Let's be clear. The Republican demands are pure politics, not a 
serious solution to a serious problem.
  Currently, over 90 percent of people on Medicaid are either employed, 
in school, living with a disability or a debilitating illness, or 
caring for a baby or a disabled loved one. About three in four people 
receiving food assistance and 60 to 80 percent of parents receiving 
income assistance were employed within a year of being in the program. 
In fact, States that had expanded their Medicaid Program report not 
only better health outcomes and financial stability for people enrolled 
in the program but also higher employment numbers--that is higher, not 
lower, rates of employment when people can just get a little help. In 
fact, when the Congressional Budget Office studied the Republican 
Medicaid proposal, they found that it would have ``no change in 
employment or hours worked by Medicaid recipients.''
  So let's not kid ourselves. This Republican plan is not about work. 
It is about weaponizing redtape to strip healthcare and other critical 
assistance from tens of millions of Americans.
  But you don't have to take my word for it. In Arkansas, the only 
State that has implemented Medicaid work requirements, one in four 
adults who were subject to these rules lost their health coverage, 
despite the fact that 95 percent of all enrollees were already working 
or qualified for an exemption. Why? How could this happen? It happened 
because the reporting requirements were so burdensome, so difficult to 
navigate, that people--particularly, people with disabilities and 
people with chronic illnesses--couldn't run through the maze.
  That meant that more people in Arkansas were forced to ration 
medication. More had to delay medical care, and more had to take on 
medical debt. And for the cherry on the top, there is no evidence--
none--that the Arkansas policy increased the rates of employment--which 
makes sense. If you are not healthy, how are you supposed to work?
  Now, Republicans have been down this road before with SNAP and with 
TANF as well. Indeed, this is where they perfected the redtape scams. 
Now Republicans are demanding expansions to existing work requirements 
in SNAP--requirements that we already know kick people out of the 
program without having any impact on employment.
  And after Republicans implemented strict work requirements on TANF 
families, program participation dropped by nearly 20 percent in just 3 
years. Studies show that this redtape increased barriers to employment 
and led to poorer health outcomes, especially for Black and Brown 
families. This latest Republican proposal makes the maze of work 
requirements even more complex.
  But, you know, there is one group that profits from making the 
eligibility maze more complex: private contractors. Private contractors 
that make their profits by kicking recipients out of the programs or 
otherwise trapping them in a cycle of poverty. Maximus, for example, 
has earned $1.7 billion in the last decade administering redtape for 
more than half of the States, but it has been caught shoving poor 
Americans into unsustainable poverty-level jobs or even totally unpaid 
work. And then Maximus gets paid when these workers cycle repeatedly on 
and off, on and off welfare.
  By kicking millions of Americans off Medicaid, SNAP, and TANF, the 
Republican redtape scam claims to save

[[Page S1644]]

$120 billion. But keep in mind that the States will be the ones that 
will be forced to administer all of the redtape and pay the cost for 
that.
  Congressional Republicans are ready to drive our economy off a cliff, 
and why? To fulfill their dream of erasing America's safety net. Kevin 
McCarthy is the only one who won't take default off the table.
  Democrats, including President Biden, have been clear: These 
dangerous proposals are not going anywhere. We will not create a 
redtape maze that has been a complete failure every single time it has 
been tried.
  It is long past time for Republicans to stop playing games and to 
raise the debt ceiling.
  I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Oregon.
  Mr. WYDEN. Mr. President, before she leaves, I would like to thank my 
colleague for an eloquent statement that really lays this case out, and 
I am going to try to pick up now where you left it, and I thank you for 
it.
  These compelling arguments from the Senators from Pennsylvania and 
Massachusetts show the importance of Medicaid to all of us on our side, 
and I am just going to wrap up by laying out three key laws in the 
House Republican proposal to cut Medicaid.
  First, most Americans with health coverage through Medicaid are 
already working if they are able.
  Second, the House Republican plan to cut Medicaid is going to put 
millions of Americans at risk, including seniors in nursing homes. And 
I am going to describe a little bit later how that happens.
  And, third, the track record laid out by Senator Warren shows that 
working requirements have been a bureaucratic nightmare for Americans.
  It is hard, Senator Warren, to figure out how the so-called ``small 
government'' Republicans have become so fond of bureaucracy and 
redtape.
  Here is why House Republicans want to slash Medicaid by billions. 
They say it is about work. It is really about securing an ideological 
trophy on the evidence-free proposition that Americans near the poverty 
line are actively choosing to stay there instead of working.
  So what has this work reporting requirement really been about? It has 
been about ripping away health coverage from Americans who Republicans 
have judged to be unworthy.
  Don't take it from me. An analysis from the Kaiser Family Foundation 
paints a pretty clear picture of who is going to be at risk of losing 
coverage.
  As of 2021, there are 25 million adults ages 19 to 64 who are 
enrolled in Medicaid. Forty-three percent are working full time, and 18 
percent are working part time. I will stop right there and note that 
that is equal to the national labor force participation rate at 61 
percent.
  For the remainder with Medicaid coverage who are not working, 13 
percent are caregiving for a child or relative; 11 percent are unable 
to work because of illness or disability; 6 percent are attending 
school. The remaining 9 percent of Americans are not working because 
they are retired or unable to work.
  Here is the catch. Under the House Republican scheme, the majority of 
these Americans would be forced to report to the States whether they 
are working and how much, each and every month, under the threat of 
losing their health insurance. My Republican colleagues are fond of 
sharing their small government bona fides, but to me that sounds like a 
lot of bureaucratic redtape. What is worse, the Congressional Budget 
Office found in an analysis just last year that these work requirements 
that we are talking about did not increase employment.
  Mr. President, now I am going to explain how this ill-conceived 
proposal is going to hurt more Americans than those who are subject to 
work requirements.
  The House Republican bill cuts Medicaid by over $100 billion. It 
comes from one source: Americans getting kicked off Medicaid. The only 
way for Americans to retain Medicaid coverage would be for States to 
pick up the whole bill. That means you are just shifting the Federal 
share of Medicaid on to States that don't want to saddle their health 
programs with more bureaucracy and bureaucracy that has never been 
shown to increase employment.
  Shifting Medicaid costs to States has real consequences. This is not 
some kind of abstract theory. When the Federal Government reduces how 
much it contributes to a State's Medicaid Program, the State has to 
make up the difference. That means States face tough choices about 
which Americans will have health coverage and whether hospitals and 
nursing homes are going to face funding cuts which threaten their 
ability to stay open. Doctors could see their pay cut. State options, 
like a full year of postpartum care, which Congress created on a 
bipartisan basis, something which has been of special importance to the 
Presiding Officer, would be subject to cancellation.
  These cuts will jeopardize our parents' or spouse's access to 
Medicaid nursing home benefits or cut resources for home care, which 
allows people with disabilities and the elderly to receive care in 
their homes instead of moving into an institution.
  Unfortunately--and I will close with this--there are real-world 
examples to illustrate what happens when a State conducts 
counterproductive bureaucratic requirements. During the Trump 
administration, Federal health Agencies allowed Arkansas to conduct 
this work reporting experiment. Within the first year, 18,000 people 
lost Medicaid coverage, about a quarter of those subject to work 
reporting. A year later, nearly 90 percent of those who lost coverage 
had not reenrolled. Those who were enrolled in the Arkansas Works, as 
it was titled, program painted a very bleak picture. Reporting their 
work was all kinds of redtape. The website was down nights and 
weekends, supposedly for maintenance, and plagued by errors, difficult 
to access on mobile devices. Calling the help line resulted in an 
endless parade of robotic questions and dead ends.
  These are just some of the hoops that bureaucrats designed primarily 
to keep Americans from health coverage. Keep in mind that these are 
families who walk an economic tightrope every week, balancing food 
against housing, housing against transportation. Many don't have 
reliable access to the internet or a cell phone, especially true in 
rural areas.
  It is no secret that affordable health coverage is critical to 
staying healthy and financially stable. If you need medical treatment 
but you can't afford it, getting or keeping work up is going to be that 
much harder. That is why this policy envisioned in the House is upside 
down and cruel. It slams the door and throws away the key on Americans 
trying to get back on their feet. The reality is that having Medicaid 
health coverage supports Americans' ability to join the workforce. It 
doesn't deter them from working.
  And it is not just Medicaid that the House Republicans want to come 
after. My colleagues talked about food assistance, like SNAP. I mean, 
you talk about food assistance, a real lifeline to people staying 
healthy.
  Even in the early months of this Congress, I want to say tonight that 
it is possible to find lots of room for bipartisan agreement on 
healthcare. Right now, I am working closely with my partner on the 
Senate Finance Committee, my colleague from Idaho Senator Crapo, to 
take on the drug middlemen known as the pharmacy benefit managers. I am 
confident that we can find common ground, and we will be on the Senate 
floor with this idea to make a positive, bipartisan change for American 
families.

  For everybody who is paying attention to this, it is not a big secret 
that there are other ways to save taxpayer dollars. You know, last 
week, the Senate Finance Committee dug into the question of how the big 
pharma companies generate their sales. Almost all of them are in the 
United States, and then for purposes of paying taxes, they race 
overseas for lower rates and hiding their profits.
  I will close by saying that, in cutting vulnerable people, like I 
think is going to happen with all of this back-and-forth in States that 
are trying to figure out how to pay their bills, it is going to hurt 
nursing home patients.
  What this is all about is the House is going to create an entirely 
new level of bureaucracy and paperwork, all in the name of taking away 
health coverage for more Americans. This is not a proposition that 
colleagues on this side of the aisle are going to support.
  I want it understood as we wrap up, as chairman of the Senate Finance

[[Page S1645]]

Committee, I am going to work with my colleagues on our committee and 
throughout this side of the Chamber to fight these policies that come 
after Medicaid. We will fight them every step of the way because they 
are wrong, wrong, wrong.
  I yield the floor.
  The ACTING PRESIDENT pro tempore. The majority leader.

                          ____________________