[Congressional Record Volume 170, Number 146 (Thursday, September 19, 2024)]
[Senate]
[Pages S6204-S6208]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
CLOTURE MOTION
The PRESIDING OFFICER. Pursuant to rule XXII, the Chair lays before
the Senate the pending cloture motion, which the clerk will state.
The bill clerk read as follows:
Cloture Motion
We, the undersigned Senators, in accordance with the
provisions of rule XXII of the Standing Rules of the Senate,
do hereby move to bring to a close debate on the nomination
of Executive Calendar No. 700 Rose E. Jenkins, of the
District of Columbia, to be a Judge of the United States Tax
Court for a term of fifteen years.
Ron Wyden, Alex Padilla, Debbie Stabenow, Catherine
Cortez Masto, Mark Kelly, Jack Reed, Tim Kaine, John W.
Hickenlooper, Christopher Murphy, Robert P. Casey, Jr.,
Richard Blumenthal, Benjamin L. Cardin, Christopher A.
Coons, Margaret Wood Hassan, Chris Van Hollen, Tammy
Baldwin, Tina Smith.
The PRESIDING OFFICER. By unanimous consent, the mandatory quorum
call has been waived.
The question is, Is it the sense of the Senate that debate on the
nomination of Rose E. Jenkins, of the District of Columbia, to be a
Judge of the United States Tax Court for a term of fifteen years, shall
be brought to a close?
The yeas and nays are mandatory under the rule.
The clerk will call the roll.
The bill clerk called the roll.
Mr. DURBIN. I announce that the Senator from Oregon (Mr. Wyden) is
necessarily absent.
Mr. THUNE. The following Senators are necessarily absent: the Senator
from Tennessee (Mrs. Blackburn), the Senator from Kansas (Mr.
Marshall), the Senator from Kansas (Mr. Moran), the Senator from South
Dakota (Mr. Rounds), the Senator from Missouri (Mr. Schmitt), the
Senator from North Carolina (Mr. Tillis), the Senator from Alabama (Mr.
Tuberville), and the Senator from Ohio (Mr. Vance).
Further, if present and voting: the Senator from North Carolina (Mr.
Tillis) would have voted ``yea.''
The yeas and nays resulted--yeas 76, nays 15, as follows:
[Rollcall Vote No. 248 Leg.]
YEAS--76
Baldwin
Barrasso
Bennet
Blumenthal
Booker
Britt
Brown
Budd
Butler
Cantwell
Capito
Cardin
Carper
Casey
Cassidy
Collins
Coons
Cornyn
Cortez Masto
Cramer
Crapo
Daines
Duckworth
Durbin
Fetterman
Fischer
Gillibrand
Graham
Grassley
Hassan
Heinrich
Helmy
Hickenlooper
Hirono
Hoeven
Hyde-Smith
Johnson
Kaine
Kelly
Kennedy
King
Klobuchar
Lujan
Lummis
Manchin
Markey
McConnell
Merkley
Murkowski
Murphy
Murray
Ossoff
Padilla
Peters
Reed
Ricketts
Risch
Romney
Rosen
Sanders
Schatz
Schumer
Shaheen
Sinema
Smith
Stabenow
Tester
Thune
Van Hollen
Warner
Warnock
Warren
Welch
Whitehouse
Wicker
Young
NAYS--15
Boozman
Braun
Cotton
Cruz
Ernst
Hagerty
Hawley
Lankford
Lee
Mullin
Paul
Rubio
Scott (FL)
Scott (SC)
Sullivan
NOT VOTING--9
Blackburn
Marshall
Moran
Rounds
Schmitt
Tillis
Tuberville
Vance
Wyden
The PRESIDING OFFICER (Ms. Butler). On this vote, the yeas are 76,
the nays are 15.
The motion is agreed to.
The Senator from Connecticut.
Healthcare Ownership
Mr. MURPHY. Madam President, when I was growing up, I had a
pediatrician. His name was Dr. Cartlon. He was kind. He was reassuring.
His advice and his comfort meant a lot to my parents, who were young
parents and in need of a steady shoulder to lean on
[[Page S6205]]
when their kids were born. I remember Dr. Cartlon distinctly even
though he retired when I was pretty young, and I remember that he was a
really important part of my family's support system. He was an
important part of our community and family identity.
My kids don't have a pediatrician; they have many pediatricians. That
is because the big pediatric practice that we use decided that it was
inefficient and not cost-effective to assign one pediatrician to every
family.
Every time we book an appointment, we go see a different doctor at
this practice. They are all competent. Our kids are healthy. This very
efficient system--it does mean that we probably get in to see a doctor
faster than when my parents were trying to find a last-minute
appointment with only a very busy Dr. Cartlon. It is an efficient
system, but it is hollow. I don't know any of the doctors' names. We
have no relationship with one pediatrician. It is clinical. It is not
personal. And while we get good care, I admit it leaves you feeling a
little bit empty, a little bit alone, as if you are just a number or a
name in an appointment book. Without a Dr. Cartlon that you can count
on, that experience is a little less assuring.
So I got curious, and I looked up who owns this very competent, very
efficient pediatric practice that we use. What I learned is that the
primary investor in our children's pediatric practice is Goldman Sachs.
A Wall Street investment bank owning your children's pediatrician
would have sounded silly to Americans a generation ago, but today, the
role of private equity and hedge funds and big banks in healthcare
ownership is one of the most important stories in healthcare, and by
and large, it is bad news for patients.
Right in front of our eyes, the defining purpose of our healthcare
system is being transformed. Our hospitals and our nursing homes, our
hospice care, even our kids' pediatric practices now exist often for
the primary purpose of making obscene amounts of money for investors.
It is not about keeping us healthy; it is about return on investment.
That is what I want to spend a few minutes talking to my colleagues
about today.
Historically, you could count on your doctor's office and your
nearest hospital to be locally owned, likely to be not-for-profit, and
trust that the reason they existed was to make sure that patients got
the care they needed. The people that owned the healthcare institutions
you counted on lived in your community. They didn't answer to New York
private equity firms or Los Angeles investment companies; they were
accountable to you, to their neighbors.
That really mattered. It made you feel safe. It reassured you that
you or your loved ones were in good hands--because ultimately that is
the only thing that matters. When we are at our most vulnerable--
whether that be because of something joyous, like a pregnancy, or
something more worrying, like a difficult diagnosis--all we want to
know is that the priority at that institution that we or our loved one
is at is that we are being taken care of, that the primary motivation
of the person taking care of us is taking care of us, but increasingly,
that is no longer the case.
Let's just take for today private equity firms--companies that buy up
companies, extract as much rent from them as possible, and then quickly
turn them over to the next highest bidder.
Over the past decade, private equity investors have spent more than
$1 trillion acquiring hospitals, nursing homes, and physician
practices. You can see here in this chart that private equity acquired
six times as many medical practices in 2021 compared to just a decade
earlier, in 2012.
The reach today of private equity in our healthcare system is
enormous. Think everything from specialists, like OB/GYNs and
anesthesiologists, to generalists, like primary private care providers
and emergency services and urgent care. You might not even know that
the new doctor you are seeing or the place where you are getting your
blood work done is owned not by anybody in your community but by a far-
off private equity firm.
To understand why this is so dangerous, you just have to understand
what private equity is all about and how it makes a very small number
of people a ton of money. The playbook is pretty simple. Private equity
firms invest in companies--largely through borrowed money--then flip
them for a quick profit to enrich themselves and their investors. It is
called buy, strip, flip.
Buy: The private equity firm uses a leveraged buyout normally,
meaning they put up a small amount of their own money and borrow all
the rest, immediately saddling their new purchase with huge amounts of
debt.
Strip: They comb through the balance sheets to find as many cost-
cutting opportunities as possible. They lay off workers. They stop
paying vendors. They even might sell the land underneath the company
that they bought, giving themselves a big one-time payout, leaving the
company to pay rent on the space that they used to own.
And then flip: They find a new buyer or they get bailed out by
somebody--sometimes even government--and walk away richer than before
and completely insulated from any legal or moral fallout from the
consequences of their actions.
Short-term profit is the priority, and in the healthcare system, that
comes with real risk and downside because at the moment you are most
vulnerable, you want to make sure that the priority is taking care of
you.
Let me tell you a story to give you a little example about how this
works. Prospect Medical Holdings is a safety-net hospital operator,
which means they provide healthcare to people who are on Medicaid,
people who don't have insurance. Prospect was acquired by a private
equity firm in 2010 and currently owns 16 hospitals in this country in
Pennsylvania, California, Rhode Island, and Connecticut.
Before we get into the details, let's talk about how a private equity
firm buys a hospital. They raise capital from investors, but a huge
portion of the money they raise, as I mentioned before, is borrowed. So
from the start, the hospital that they are buying is millions of
dollars in debt, additional debt, and is immediately responsible for
generating revenue to pay that debt--debt that the hospital didn't
acquire, debt that is on the hospital because the ownership company
borrowed the money in order to buy the hospital. Sometimes that means
taking a bad financial situation and ultimately replacing it with an
even worse one.
So in 2016, this company, Prospect, bought three hospitals in my
State--Rockville General, Manchester Memorial, and Waterbury Hospital--
for a total of $150 million. Combined, these hospitals serve about
600,000 patients. They employ about 4,000 people.
For most of the people who live in this area, these hospitals are
their best and sometimes their only option. Access to emergency rooms,
especially if you live in one of the more rural parts of the State, can
be a matter of life and death. Many of the patients are on Medicare and
Medicaid, and they might not have access to transportation that would
allow them to get to a hospital farther away.
I should note that 80 percent of Prospect's revenues come from
Medicare and Medicaid reimbursement, meaning this company and the
hospitals it owns are largely funded by us, by taxpayers.
These hospitals in Connecticut, I will admit, weren't in great
financial shape when they were bought. But they were hopeful that these
new owners--these new owners with lots of money at their disposal--
would bring an infusion of investment--that is what was promised--and
would help right the ship.
Two years after their purchase, the hospitals in Rockville,
Manchester, and Waterbury hadn't seen much of any improvement or
investment. In fact, they were beginning to fall into greater
disrepair. As the three of them entered some pretty dire financial
straits, Prospect didn't make further investments. They took out a $1.1
billion mortgage and made these hospitals the collateral. Surely, they
put some of that money--they used the hospitals as collateral. They
raised $1.1 billion. Surely, they put that money back into the
hospitals to pay for the repairs and improve their financial
situations.
You know the story. They didn't do that. In fact, half of that loan--
they used the hospitals for collateral. Half of that loan went to
dividends to investors and executives across the country in California,
where Prospect was located. And $90 million went straight to
[[Page S6206]]
one person, the CEO. Let me guarantee you, $90 million would have made
a huge difference at Waterbury Hospital. It would have saved lives. But
Waterbury Hospital was used as collateral so that Sam Lee, the CEO,
could make $90 million. Next to nothing went toward a single one of the
16 hospitals that Prospect owns across the country. Prospect owes the
State of Connecticut $67 million in unpaid taxes. They owe the low-
income city of Waterbury, which struggles to pay its elementary school
teachers, $10.5 million. None of that money went to pay the taxes they
owe Connecticut and the city of Waterbury.
Prospect's CEO made $90 million while his company refused to pay
taxes. But maybe, you ask, the CEO really needed the money. Well, he
didn't. It is just greed. This guy, Sam Lee, I don't know him, but he
owns not one but two luxury homes in Los Angeles. They are worth more
than $15 million combined. Each of them has its own pool. One even has
its own private basketball court. They are 11 minutes from each other.
Sam Lee pillaged three Medicaid hospitals in Connecticut so he could
have two mansions 11 minutes apart.
But here is the real problem. Sam Lee isn't the exception; he is the
rule.
We just finished up a set of hearings in meetings on Steward Health
Care, which used the same playbook as Prospect to run their hospitals
into the ground while their out-of-State CEO also cashed out. The
hospitals Steward bought in Louisiana and Massachusetts were gutted.
A nurse testified before our committee this month that they put dead
babies in cardboard boxes because they wouldn't pay for the kind of
temporary coffin that would normally be used for a dead child. The
nurses would leave during the day to go to local stores to buy basic
supplies on their own dime because they didn't have them in the
hospital.
The elevators in these Steward Health Care hospitals stopped working.
Why? Well, in this case, it is so that CEO, Ralph de la Torre, who
ignored a congressional subpoena to appear before the HELP Committee
this month, could buy a $40 million, 190-foot yacht with six bedrooms
that costs $4 million a year just to keep in the water--dead babies in
cardboard boxes so that a CEO could burn $80,000 a week on a crew and
shrimp cocktails and champagne for his private yacht. That is obscene.
That is revolting. But that is our choice. That is the healthcare
system that our laws currently allow to exist.
What is happening at Prospect and Steward is happening all over the
country. I am not saying that every private equity firm is as rapacious
as those that I am talking about today. And private equity firms will
tell you these hospitals and nursing homes were inefficient before they
bought them, and they will claim that the private equity ownership
increased efficiency and quality.
But here is maybe the most important thing to tell you. It is just
not true. Yes, as I explained with regard to my own pediatric practice,
efficiency--profit-maximizing efficiency--is often not good for the
well-being or the peace of mind of patients. My kid's pediatric
practice is efficient, but it doesn't deliver the same kind of
satisfaction and peace of mind as it does when you have a reliable
pediatrician.
But, more importantly, there is actually no evidence that private
equity ownership increases quality or reduces costs. As I am going to
tell you, the evidence suggests exactly the opposite is true.
A recent study from Harvard Medical School asked the simple question:
Are patients at hospitals acquired by private equity receiving worse
care than patients at hospitals not owned by private equity?
Researchers analyzed insurance data from almost 5 million Medicare
hospitalizations for 10 years, and the findings were stunning, though
not surprising.
After a hospital was acquired by a private equity firm, there was a
25-percent increase in complications for patients. Patients experienced
27 percent more falls, 38 percent more bloodstream infections. The rate
of surgical site infections was double that of hospitals not owned by
private equity. Those are stunning numbers. This is not patient care
being 5 percent worse, 10 percent worse. You are talking about
infection rates after surgeries having doubled, just because a private
equity firm owns it, rather than the hospital being in the hands of the
local community.
Why? When private equity takes over, it is mostly not about the
patient. It is about the profit. How do you maximize profit really
quickly? You have to do it really quickly because you have to start
paying back those loans you took out to buy the hospital. You have to
start getting ready to flip the asset. You have to make the rich CEOs
even richer.
What do you do? You fire employees to cut costs. You force the
remaining doctors and nurses to just see more patients for less time.
You cut corners on supplies and equipment. You discharge patients much
more quickly if that makes you more money.
OK, that is quality. But what about cost? It turns out that private
equity ownership is driving up costs for premium payers and taxpayers.
One study looked at what happens when a private equity firm engages in
a rollup strategy, otherwise known as buying up a lot of small doctor
groups in the same market. That study found that in 8 out of 10
specialities they looked at, from oncology to primary care, the price
of care went up after these private equity rollups by as much as 16
percent.
So when private equity buys up a healthcare practice, quality goes
down, satisfaction goes down, cost to consumers and the government goes
up.
It begs a larger question: How has capitalism gone so far off the
rails? How have the rules of our economy become so unmoored from the
common good and any conception of morality? No one in this country
would endorse the healthcare system in which nurses at a hospital are
forced to go to the local CVS because the emergency room ran out of
Pedialyte, just so the hospital owner could pay for the expensive
upkeep of a luxury boat. Nobody in this country thinks it is OK for a
hospital CEO to refuse to pay taxes so he can easily make his mortgage
payments on his two luxury homes 11 minutes away from each other.
These private equity CEOs, who are hurting people in order to fund
their lavish lifestyles, most of them don't think they are doing
anything wrong. They think they are just playing by the rules. And to
an extent, they are right, because our government, our culture, and our
society have deemed it OK for people to make a fortune even when it
comes at the expense of hurting other people.
Listen, there are parts of the economy where maximizing profit aligns
with maximizing quality, but healthcare is not one of them. People are
dying in these hospitals and nursing homes so that the executives can
get rich. That is not right, and we don't have to accept it.
We can build a free-market economy that has guardrails to protect
against the worst kind of immoral greed and excess. I don't begrudge
anybody making money, but if you are making money off the most sacred
parts of our economy, like our Medicaid hospitals, and you are making
money basically by funneling taxpayer dollars to your own pocketbook,
there has to be a limit.
And, today, I am just outlining the problem. But make no mistake,
there are solutions. Congress and the President do not have to accept
this trend of private equity ownership in our healthcare system and the
abuse that it allows.
For instance, the Biden administration and the FTC, through Chair
Lina Khan, are taking these risks seriously. They are filing anti-trust
suits against private equity-backed healthcare monopolies.
In the Senate, the HELP Committee, as I mentioned, just finished a
hearing on the abuses of that one company, Steward Health Care, and we
heard outrage from both Republicans and Democrats on the committee.
When that CEO refused to testify--ignored the subpoena--Republicans and
Democrats voted to sanction him for that illegal action. Congress can
take a stand and limit or restrict private equity or investor ownership
of healthcare institutions that receive a bulk of their revenue from
Federal programs like Medicare or Medicaid.
Let's be clear. This is not the only problem in the American
healthcare system. We have a lot of work to do to increase quality and
reduce costs. But this new phenomenon--the
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financialization of healthcare and the rapidly increasing ownership of
healthcare intuitions by private equity--has happened virtually
overnight, with little public discussion, and it has made all of the
failures that already existed in our healthcare system 100 times worse.
It has been a boon to the private yacht industry, but it has been
largely miserable for patients.
It might feel like this train has left the station, but it has not.
It is not too late to turn it around. Congress can and should act.
I yield the floor.
The PRESIDING OFFICER (Mr. Booker). The President pro tempore.
Abortion
Mrs. MURRAY. Mr. President, I rise today to speak about a new
resolution that I introduced which reaffirms the basic principle that
when you go to the ER, they should be allowed to treat you.
When your life is in danger, doctors should be able to do their job.
And when you need emergency care, including an abortion, no politician
should stop you from getting it. This is so simple.
And yet, when President Biden and Vice President Harris tried to make
that clear, Republicans worked to stop them, opposing the basic notion
that, yes, ER doctors might have to provide emergency abortion care to
save a woman's life.
Make no mistake, we are talking about women whose water breaks
dangerously early or who are experiencing uncontrollable hemorrhage or
sepsis or preeclampsia.
These are patients we are saying doctors should treat under the basic
right to emergency care. These are the women Republicans don't think
deserve access to emergency care.
I don't know where on the long path of anti-abortion extremism that
saving lives became a bridge too far for so many Republicans, but that
is where we are. It is not just an extreme position, it is a very
dangerous one, and it is a deadly one.
There are so many tragic stories about how Republican abortion bans
are hurting women. Those stories include women who have been unable to
get an abortion after a pregnancy became bad for their health, unable
to get one after the situation had become a medical emergency, unable
to get one until the only option was a hysterectomy that totally ends
their dream of having a child one day, and in some heartbreaking cases,
women have been unable to get an abortion until it is too late. They
have died. They have died because Republican bans denied and delayed
the care they needed.
Just this week, we heard the stories of two Black mothers who lost
their lives in Georgia due to the State's draconian abortion ban.
According to a report from ProPublica, in 2022, after Georgia's 6-week
abortion ban went into effect, a pregnant woman went into the ER. She
was a single mom. She had a serious infection and needed a D&C. That is
a routine procedure and the standard of care for her condition.
Her case was not a mystery, but even if it was clear that a D&C would
save her life, it was not clear her doctors could provide that without
facing legal danger under their State's abortion law. Her condition
worsened. Her blood pressure dropped. Her organs started failing. And
by the time she got the procedure, 19 hours after she arrived at the
ER, it was too late, and tragically she died.
The State's medical review committee concluded there is a good chance
she would have survived if the procedure had happened sooner. Her name
was Amber Thurman.
Another Black woman in Georgia died without ever seeking medical
care. She was too afraid to see a doctor given ``the current
legislation on pregnancies and abortions.''
The State's medical review committee also found her death to be
preventable, a heartbreaking outcome for the three children she left
behind. Her name was Candi Miller.
How can that be the status quo in our country in the 21st century?
How is anyone OK with this? How does anyone think that these extreme
abortion bans are a good idea? How does anyone oppose clarifying women
have a right to emergency care? Don't we want our hospitals to save
lives?
How can anyone look at this wreckage? How can you hear the stories
from doctors who are wracked with guilt for decisions Republican
politicians made for them? How can you hear the stories from these
women who have bled and suffered and died? How can anyone hear the
chilling accounts of women who have died and just shrug it off and say,
``Well, I am sure this will blow over'' or ``It wasn't so bad''?
And yet we have Republicans, by and large, just trying to ignore this
and trying to get everyone to whistle past the graveyard that they
spent decades digging.
As if a woman would ever in her life forget the time her doctor said:
Yes, you are in danger; yes, we know how to treat you; but, no, I can't
do it--politicians won't let them.
As if a mother would ever forget losing her daughter because she was
denied care; as if a husband would ever forget losing his wife; as if a
kid growing up without a mother because she was denied emergency
abortion care will ever, ever for a single day of their life forget
this.
We have Republican-led States hearing from providers about how
completely unworkable and dangerous these bans are and not really
lifting a finger to meaningfully address this problem. We have States
where people are trying to put it to the voters, trying to let the
people have their say on these bans, and Republicans have been fighting
those tooth and nail, tooth and nail, to block them--just to let people
have their say.
And we have Donald Trump still, after all this has happened, saying
everyone wanted Roe overturned. That is what he said. Everyone wanted
Roe overturned? Whom is he listening to? He is saying it is great
States can cause this chaos; it is great politicians can effectively
lock patients out of an emergency care room.
Make no mistake, this is the post-Roe world Republicans spent decades
fighting for. This is the policy outcome that Trump and Republicans
moved Heaven and Earth to achieve, and they make that clearer and
clearer every time they not only refuse to lift a finger to stop it,
but Republicans even filed a brief telling the Supreme Court,
essentially: No, we don't think doctors should be required to provide
abortion care when a patient's life is at stake--when a patient's life
is at stake.
If Republicans thought even in the slightest that this is a problem,
they could start by cosponsoring our resolution saying it is a problem.
This should not be a hard step. Let's see who takes me up on that
offer. I am waiting to see.
When I think about the carnage that Republican abortion bans have
caused, I truly cannot put my outrage into words, but I can be here,
and I can share the horror stories I am hearing on the Senate floor and
give voice to those patients and providers who are living this
nightmare firsthand: dying women being turned away from an emergency
room, being left to bleed out, left to get sicker, left to miscarry on
their own. The lucky ones--the lucky ones--get airlifted to a State
like mine where abortion is legal and protected.
By July of this year, one hospital in Idaho, next to my State, had
already airlifted six pregnant women out of the State for emergency
abortion care. The unlucky ones died.
We can't look away from this hard reality: here in America, in the
21st century, pregnant women dying not because doctors don't know how
to save them but because doctors don't know if Republicans will let
them.
As the Presiding Officer well knows, we have a maternal mortality
crisis in this country, and these bans are making it worse. We are
moving in the wrong direction. And to Republicans who have the gall to
talk about exceptions for the life of the mother, while arguing against
abortion care as emergency care, even when it is lifesaving, what do
you think emergency care is for? What do you think emergency care is
for?
And let's be clear, providing emergency stabilizing care is the bare
minimum to keep a patient alive. These women may have undergone
tremendous trauma and suffering up until they meet the threshold for
emergency stabilizing care. It should never have to get to that point.
Women should not have to lose organ function before they can get
medical care. They shouldn't have to bleed out
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in a parking lot. They shouldn't have to be left to miscarry on their
own.
Their husband shouldn't have to find them, when he comes home,
bleeding and unconscious and call 9-1-1 in a panic. This is what is
happening, and I know the Presiding Officer feels the same; we are not
going to stand for this. This will not become a new accepted normal,
period.
Democrats are going to continue to be here to tell these women's
stories. We are going to continue pressing to fully restore
reproductive freedoms for every woman in America, and we are going to
continue to be putting a white-hot spotlight on the devastating, deadly
fallout of Republicans' extreme anti-abortion policies of Donald Trump
abortion bans and on the cruel callousness Trump has offered in
response--never missing an opportunity to gloat about overturning Roe
v. Wade.
Women and families are listening to him gloat. They are not going to
forget, and I know we won't.
I yield the floor.
The PRESIDING OFFICER. The President pro tempore.
____________________