[Congressional Record Volume 171, Number 57 (Monday, March 31, 2025)]
[Senate]
[Pages S1931-S1959]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                        PRIVILEGES OF THE FLOOR

  Mr. DURBIN. Mr. President, I ask unanimous consent that DeNay Adams, 
Quentin Mansfield, Victoria Esparza, and Kelsey Handschuh be granted 
floor privileges until April 3, 2025.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. WICKER. Mr. President, I ask unanimous consent that the following 
law clerks on Senator Capito's staff be granted floor privileges until 
April 4, 2025: Camryn Runyon, Megan Banke, and Harry Kazenoff.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The PRESIDING OFFICER. The Senator from New Jersey.


                          Trump Administration

  Mr. BOOKER. Mr. President, I am really grateful you are in the Chair 
and grateful to be able to rise right now and speak.
  I want to say at the top that I have a tremendous love for this 
institution, and a lot of that is born from the people that are here--
from the pages I get to know in every class, to the folks that work the 
door, the clerks, the Parliamentarians. It is a special place, and a 
lot of people who are known here are not the ones that really keep this 
place functioning.
  I come in here days and I have good moods or bad moods but always 
find myself lifted when I walk onto this floor. It is a sacred civic 
space. It is extraordinary. And I am always aware of the weight of 
history when I walk in here. No matter a good day, bad day, whether I 
am in a rush or not, when I touch the Senate floor, I feel something 
really magnificent.
  I don't think that our Founders would have ever imagined a body like 
this with Black people on both sides of the aisle, with women serving 
here, with folks from many different backgrounds. We are in many ways 
doing what the Founders had envisioned, which was this idea of every 
generation making this a more perfect Union.

[[Page S1932]]

  But there have been times in this journey where our Union was in 
crisis and was in peril. There were times in this great American 
journey, over our 250 years, where so many heroes had to emerge, people 
that I have come to revere, like Joshua Chamberlain from Maine, who 
played such a pivotal role in the Battle of Gettysburg. What a noble 
soul he was. He would later go on to be Governor of his State and go on 
to do great things, but his heroism lay that in a time of crisis, he 
stood up.
  I know there are veterans in this body--I admire them so much--who 
have answered that call to serve our country and put their lives in 
sacrifice.
  There are people I admire that are heroes of mine that were 
suffragettes. There were people who fought as abolitionists. There are 
people more recently that I have come to lionize and admire because 
they did so much for this country--not with titles, not with high ranks 
or positions, but folks who, when this country was facing crossroads, 
was facing crises, they stood up. They spoke up.
  One of my greatest heroes of life was a man I got to serve with named 
John Lewis. I served with him while in this body. Every opportunity I 
had, I would ask him about the times when he was just a 20-something. 
He was the youngest person who was a feature speaker on the March on 
Washington. He was called the bravest man in the civil rights movement 
because he kept putting himself in harm's way to dramatize, to let 
folks know, to bring attention to the injustices in this world and to 
say very strongly that this--what was going on in our country--is not 
normal, that what is going on in our country is wrong.
  I stand on this floor as a U.S. Senator, but I revere people who 
never stood on this floor; people who, before they even got to their 
thirties and forties and fifties in life, were out there as great 
patriots fighting for this Nation.
  I rise today in an unusual manner, and I want to be clear and explain 
that. But I just want to tell you what John Lewis said. It is a quote 
so many people know. He really spoke not to Members of the Senate or 
the Congress; he was really speaking to Americans. He said:

       Get in good trouble, necessary trouble, and help redeem the 
     soul of America.

  John Lewis died in 2020, in July, at a time that--it was Donald 
Trump's first term in office. He did what Congresspeople did, but he 
also did some really extraordinary things to fight for healthcare.
  My friend Chris Murphy knows about that. He was there when John Lewis 
did an open Facebook chat--not in this Chamber or the House Chamber; he 
sat on the steps, and people were there. I remember when he did a sit-
in. They had to shut the cameras off him. He got in good trouble on the 
House side too.
  So I start tonight thinking about him. I have been thinking about him 
a lot during these last 71 days--``Get in good trouble, necessary 
trouble, and help redeem the soul of America,'' and I had to ask 
myself, if he is my hero, how am I living up to his words?
  I think Democrats and Republicans have made a lot of mistakes. No 
side has a monopoly on the truth. No side has been perfect servants of 
this country. But what has happened in the last 71 days is a patent 
demonstration of a time where John Lewis's call to everyone has, I 
think, become more urgent and more pressing. If I think it is a call 
for our country, I have to ask myself, how I am living these words?
  So tonight, I rise with the intention of getting in some good 
trouble. I rise with the intention of disrupting the normal business of 
the U.S. Senate for as long as I am physically able. I rise tonight 
because I believe sincerely that our country is in crisis. And I 
believe that not in a partisan sense because so many of the people that 
have been reaching out to my office in pain, in fear, having their 
lives upended--so many of them identify themselves as Republicans. 
Indeed, in conversations from in this body, to in this building, to 
across my State, and recently in travel across the country, Republicans 
as well as Democrats are talking to me about what they feel is a sense 
of dread about a growing crisis or what they point to about what is 
going wrong.

  The bedrock commitments in our country that both sides rely on--that 
people from all backgrounds rely on--those bedrock commitments are 
being broken. Unnecessary hardships are being borne by Americans of all 
backgrounds. Institutions which are special in America, which are 
precious, which are unique in our country, are being recklessly--and I 
would even say unconstitutionally--affected, attacked, even shattered.
  In just 71 days, the President of the United States has inflicted so 
much harm on Americans' safety, financial stability, the core 
foundations of our democracy, and even our aspirations as a people from 
our highest offices, a sense of common decency. These are not normal 
times in America, and they should not be treated as such.
  John Lewis and so many heroes before us would say that this is the 
time to stand up, to speak up. This is the time to get in some good 
trouble, to get into necessary trouble.
  I can't allow this body to continue without doing something 
different, speaking out. The threats to American people and American 
democracy are grave and urgent, and we all must do more. We all must do 
more against them.
  But those 10 words--``If it is to be, it is up to me''--all of us 
have to think of those 10 words, those 10 two-letter words--``If it is 
to be, it is up to me''--because I believe generations from now will 
look back at this moment and have a single question: Where were you? 
Where were you when our country was in crisis and when American people 
were asking for help: Help me. Help me. Did we speak up?
  When 73 million American seniors who rely on Social Security were to 
have that promise mocked, attacked, and then to have the services 
undermined, to be told ``There will be no one there to answer if you 
call for help''; when our seniors became afraid and worried and 
panicked because of the menacing words of their President, of the most 
wealthy person in the world, of Cabinet Secretaries, did we speak up?
  When the American economy, in 71 days--71 days--has been upended; 
when prices at the grocery store were skyrocketing and the stock market 
was plunging; when pension funds, 401(k)s were going down; when 
Americans were hurting and looking up; when the resounding answer to 
this question was no--are you better off economically than you were 71 
days ago?--where were you?
  Did you speak up at a time when the President of the United States 
was launching trade wars against our closest allies, when he was firing 
regulators who investigate America's biggest banks and biggest 
corporations to stop them from taking advantage of the little guy or 
the little gal or my grandmother or your grandfather, dismantling the 
Agency that protects consumers from fraud--the only one whose sole 
purpose is to look out for them?
  Did you speak up when the President of the United States, in a way 
that is so crass and craven, peddled his own meme coin and made 
millions upon millions upon millions of dollars for his own bank 
account at a time so many are struggling economically?
  Did you speak up when the President of the United States did what 
amounts to a car commercial for the richest man in the world right in 
front of America's house, the White House?
  When the President tried to take healthcare away, where were you? Did 
you speak up? Threatening a program called Medicaid that helps people 
with disabilities, helps expectant mothers, helps millions upon 
millions of Americans. And why? Why? As a part of a larger plan to pay 
for tax cuts for the wealthiest amongst us who have done the best over 
the last 20 years, for billionaires that seem so close to the President 
that they sat right on the dais at his inauguration and sit in his 
Cabinet meetings at the White House.
  Did you speak up when he gutted public education, slashed funds for 
pediatric cancer research, fired thousands of veterans who risked their 
lives for their country; when he abandoned our allies and our 
international commitments at a time when floods, fires, hurricanes, and 
droughts are devastating communities across this country; when 
countries all around the world are banning together to do something and 
he turned his back?
  Did you speak up when outbreaks of dangerous, infectious diseases are 
still

[[Page S1933]]

a global threat, yet we have stopped engaging in the efforts necessary 
to meet those threats?
  Where were you when the American press was being censored; when 
international students were being disappeared from American streets 
without due process; when American universities were being intimidated 
into silence, challenging that fundamental idea of freedom of thought, 
freedom of expression; when the law firms that represent clients that 
may not be favored are attacked and attacked and attacked? Where were 
you? Did you speak up when they came for those firms?
  What about when the people who attacked the police officers who 
defended this building--an American democracy--on January 6; who just 
outside those doors put their lives on the line for us, and many of 
them would later die--where were you when the President pardoned them, 
celebrated them, and even talked of giving them money, people who 
savagely beat American police officers?
  Did you speak up when Americans from across the country were all 
speaking up, when more and more voices in this country were speaking 
up, saying: ``This is not right. This is un-American. This is not who 
we are. This is not America''? Did you speak up?
  So I rise tonight because I believe to be about what is normal right 
now when so much abnormal is happening that is unacceptable. I rise 
tonight because silence at this moment of national crisis would be a 
betrayal of some of the greatest heroes of our Nation, because at stake 
in this moment is nothing less than everything that we brag about, that 
we talk about, that makes us special.
  At stake right now are some of our most basic American principles 
that so many Americans understand are worth fighting for, worth 
standing for, worth speaking up for--like, if you work hard your entire 
life and pay into Social Security, it should be there for you when you 
retire, and you should not have to question that those paychecks will 
arrive and that the government should strive to improve service to you, 
not brag about cutting it; basic American principles like, if you serve 
your Nation in the military, if you put your life in danger abroad, you 
will be respected and taken care of. You will be cherished and honored 
and not forced to worry that the Federal employees who provide you with 
care, many of whom were veterans themselves, will be fired or the 
benefits that you rely on will be denied or that your healthcare needs 
won't be met; basic American principles like your child will have 
access to a high-quality public education, that every child has a 
unique genius, even our children--beautiful children--with special 
needs; they have genius; and that our children can go to school and 
parents and teachers know that they will be safe there.
  Safe now are those basic American principles; that the people you 
elect to serve you in government will represent you and not to try to 
make themselves richer, not run some scam, and call you a sucker; the 
basic ideals of our Nation that everyone's rights will be equally 
protected, and everyone will be held accountable under the law. Right 
now, all of this--things that make our country different--are under 
attack. Our constituents are asking us to acknowledge this. Everywhere 
I travel now, I hear from Republicans and Independents and Democrats 
who are afraid, who are worried, who are angry.
  I think about John Lewis, who taught me that fear is not something to 
be shunned. It is almost a signpost that you are headed in the right 
direction. It is something that is a necessary precondition. You cannot 
have great fear without great courage. John Lewis would tell us that 
this is a time for great courage. He would tell us that anger is a 
fuel. It can consume you, debilitate you, or it can fuel you to put 
yourself in the service of others. I feel, if my friend were here, if 
my hero were here, he would tell us and try to teach us that this is a 
moment to know that despair is only possible if you don't meet it as an 
agent of hope.
  If John Lewis were here, he would look at me and say: What are you 
doing? What are we doing?
  So, tonight, I rise in an unusual way. I rise with the intention to 
stand here until I can stand no longer, until I am physically unable to 
stand anymore. I am going to speak up. I am going to try to cause some 
good trouble in this body I respect so much. I am going to try to cause 
what I believe is necessary trouble. I am going to try to honor the 
legacy that I know I have inherited as an American, the legacy I think 
about when I come to this floor and feel sometimes overwhelmed with all 
of the sacrifice and struggle that had to get me here: good people who 
caused good trouble in the face of slavery; good people who caused good 
trouble in the face of the denial of the right to vote; good people who 
caused good trouble in the cause of equal rights; good people who 
caused good trouble in the fight against hate; good people who caused 
good trouble in the fight against demagogues from McCarthyism to Father 
Coughlin, to big people who showed such small character when they tried 
to suppress others. I want to cause good trouble and prove worthy of 
those who came before.
  This is not normal. Listen to America. Listen to Americans. They seem 
to always be ahead of this body. They are rising up in State after 
State, not along partisan lines, but along an American line, not 
because they hate other Americans, but because they love America. What 
does love look like in public? It looks like justice, and there is so 
much injustice going on.
  I don't know how long I can stand, but I will stand and speak up. I 
want to start by reading some of these letters to try to give folks a 
flavor of what has happened in my office for 71 days. The calls we have 
gotten have gotten more and more and more numerous. I know I am not the 
only one because the calls became so numerous to the Senate as a whole 
that it locked up the lines. There are letters I am getting and emails 
I am getting. There are people taking scraps of paper and just writing 
their hearts out and sending them in to say: These are not ordinary 
times. These are painful times, frightening times, times when people 
question what is happening to America and worry that there are powerful 
people trying to fundamentally change our Nation in a way that will 
hurt people to the benefit of the powerful and the wealthy.

  I look at these letters like this one. I won't read the name, but 
they say:

       Hi, Senator Booker. Medicaid has saved my life many, many 
     times. Without it, many people in America will die. Please, 
     help us.

  It is underlined multiple times.
  Here is another scrap of paper on which somebody writes their heart 
out:

       Dear Senator Booker, when I got out of the Navy, I had 
     mental illness. I needed psychiatric medicine to stop going 
     in and out of the hospital. Because of Medicaid, I have 
     medicine that has kept me out of the hospital for 18 years. 
     Without Medicaid and my medicine, I will wind up in the 
     hospital.

  Americans are telling me their most vulnerable pains. Their most 
terrified realities are now confronting them, rendering their pride and 
telling their truth.
  Here is another one:

       Dear Senator Booker, I am writing you today as a 
     constituent. In addition to being a concerned citizen, I am a 
     25-year employee of the local board of education and a parent 
     of a permanently disabled daughter who has just started 
     receiving Medicaid. Even with her master's degree, my 
     daughter is only able to work 19 hours a week. Therefore, 
     insurance is not provided. Medicaid is a necessity to 
     maintain her physical and emotional health and provide 
     services to assist with her independence so she can continue 
     to be a contributing member of society. By withdrawing 
     funding for Medicaid, the policy would disrupt programs 
     serving disabled and elderly people in New Jersey and 
     throughout the country. And Medicaid is only one area which 
     will potentially be affected by Donald Trump's funding 
     freeze. Please protect Social Security and Medicare for the 
     hard-working Americans who have earned it. Social Security 
     isn't a ``handout.'' We have paid into it with every paycheck 
     throughout our entire working lives, and the 66 million 
     seniors relying on Medicare could have their healthcare put 
     on hold or canceled. We deserve to know these programs will 
     be there for us. If Federal grants are limited, medical and 
     science research limited, including vaccines and disease 
     prevention, they will all be severely impacted. The United 
     States should be a world leader in healthcare and education 
     and scientific advancement. This is an embarrassment to us as 
     a country. It should not be possible in America for one 
     single man--even an elected President--to stop funds which 
     Congress has already allocated. I implore you to use your 
     power as my Senator and a key member of our government to 
     stand up for what is important to the people of your 
     district. We want to go to work, take care of our families, 
     and ensure all citizens have the health services they 
     deserve. These latest orders are inappropriate, untenable, 
     and illegal. As a Senator, please

[[Page S1934]]

     take action. Please take action to defend and protect these 
     programs. Thank you for your time.
       Cory Booker, recently it has come to my attention that my 
     students' rights in New Jersey are under threat from new 
     legislation. This has caused distress and uncertainty in my 
     classroom for my students who depend on funds from Medicaid. 
     My students depend on consistency, and a lapse in their 
     education and care would result in regression, trauma, and 
     worse. I teach students in New Jersey who are supported by 
     your legislature. I teach all abilities, meaning many of the 
     students live with ADHD, autism, and other disorders that 
     require extra care and attention. It is my life's mission to 
     bring what I know to those who want to learn it. I love the 
     job I do. I love that I get to spend time with those who need 
     it most and deliver care and education. The job that I do 
     helps my students live more independently and achieve richer 
     and more fulfilling lives. I live out of State, but most of 
     my students are from the State you help legislate. My 
     students' rights are in trouble and need you to advocate for 
     them. I urge you to continue to fight for Medicaid. Please 
     work to oppose any and all cuts or caps to the Medicaid 
     program.
       Dear Senator Booker, my name is--I am a registered voter in 
     New Jersey. I am writing today to strongly urge you and your 
     fellow policymakers to oppose all cuts to the Medicaid 
     program as it is a lifeline for individuals with 
     disabilities. Oppose all cuts or caps. I was a special 
     education teacher for 30 years, and after I retired, I 
     volunteered as a special education advocate for 10 years. I 
     had the privilege of advocating for many disabled children 
     and young adults who were receiving Medicaid services. 
     Medicaid gave many of my clients the opportunity to 
     participate in society by providing daily life skills for 
     independence. Skills reinforced through Medicare programs 
     include shopping, safety, job search, speech and language--
     just to point out a few of the services provided by Medicaid. 
     My clients require repetition of these skills to function in 
     their daily lives. Without these programs provided by 
     Medicaid, regression will occur, and learned skills will not 
     be retained. Without Medicaid, this community will struggle, 
     isolate, and lose any quality of life they have enjoyed since 
     receiving Medicaid services. Medicaid has made a critical 
     difference in the lives of my clients. Cutting and capping 
     Medicaid will have devastating consequences for them and 
     their family.
       Senator, there are 1.6 million New Jersey residents with 
     disabilities who rely on Medicaid for access to vital care, 
     resources, and essential medications needed to survive. 
     Please support and fight for these vulnerable New Jersey 
     citizens. Please take action to protect these vital programs 
     provided by Medicaid.
       Thank you in advance for your anticipated efforts in my 
     request of your support for our most vulnerable residents.

  I am going to rise tonight, as I said, and stay for as long as I 
physically can, and I am going to go through issue area after issue 
area after issue area and talk specifically to the concerns, the fears, 
the actions taken, to the hurts that are already being felt throughout 
America, elevating others' voices who don't have the privilege of 
standing in this body, honoring those Americans who, even though they 
don't have such a position, they are raising their voice. I will rise 
for as long as I can to honor them and raise mine.
  The first area I want to talk about is Medicaid, Medicare, and 
healthcare, as my constituent spoke to.
  I don't need to tell anyone the importance of healthcare to humanity. 
Without our health, we would not be able to do anything else. We would 
not be able to provide for our families, spend time with our loved 
ones, do all of the things that make life worth living. That is why I 
am going to stand here and explain to people what is going on and how 
our healthcare programs are at risk and being undermined.
  The Trump administration and Republicans in Congress are, right now, 
discussing how to cut these programs in a way of putting those savings 
either into tax cuts for the rich--I say ``either'' because they are 
going to be putting them into tax cuts for the rich, but those tax 
cuts, as we know, are still going to blow massive trillion-dollar holes 
in our deficits.
  They are trying to gut Medicaid and Medicare programs on which nearly 
a third of our country rely, all to pay for those tax cuts to 
billionaires and corporations. They are also dismantling the very 
institutions meant to safeguard our Nation's health and well-being. And 
this is not the first time.
  They tried this before during Trump's first administration when he 
unsuccessfully tried to repeal the Affordable Care Act and cut 
Medicaid, despite its popularity across the Nation, across the 
political aisle. He was going after something that wasn't left or 
right, that Americans were saying in the course of conviction that this 
is about right or wrong, and it is wrong to take away healthcare for 
millions of people.
  Let me explain, if I can, or speak to a few points from a recent 
report by Protect Our Care to explain what the administration is trying 
to do to our healthcare system. They want to slash almost a trillion 
dollars--about $850 billion--from Medicaid, forcing people to choose 
between healthcare and putting food on the table.
  In every State, hundreds of thousands of seniors, children, and 
working families could lose their health insurance, thanks to 
Republicans' plan to cut those hundreds and hundreds of billions of 
dollars from Medicaid.
  It would impose, they seek, burdensome work requirements for people 
on Medicaid. The last proposal coming from Republicans of that work 
requirement has one goal: to make it harder for people to qualify for 
Medicaid, to slash benefits, and deny up to 36 million people access to 
healthcare so they could fund, again, those tax breaks for the 
wealthiest, for corporations.
  Work requirements only increase the redtape of hard-working families 
already burdened by working multiple jobs, caring for children, and 
more. They are simply increasing the redtape working families have to 
go through to obtain affordable care.
  Their intention is also to hike premium costs. Millions of families 
who use private health insurance saved an average of $2,400 per year on 
their premiums, thanks to the Inflation Reduction Act advanced premium 
tax cuts. But now the proposals Republicans are putting forth want to 
end these savings and raise costs for over 24 million Americans.
  The proposal wants to take away protections from people with 
preexisting conditions. The GOP plans to repeal and undermine the ACA; 
meaning, if they are successful, 135 million people with preexisting 
conditions like asthma, cancer, and diabetes would lose critical 
protections, and private insurers, insurance companies can charge them 
higher premiums.
  The efforts that they are discussing--Republicans are discussing--
would raise prescription drug prices. It would stop medical research 
and stop medical debt relief.
  Over the first 3 months of his administration, Donald Trump and 
Republican allies have increased the prices of prescription drugs--
including cancer and heart medications, as well as vital antibiotics--
delayed the implementation of a Biden administration rule that barred 
medical debt from showing up on credit reports, cut NIH grants, halted 
all studies and activities within the NIH relating in any capacity to 
the health of LGBTQ Americans, including active research programs, and 
President Trump violated court orders to halt funding freezes to 
organizations like the NIH.
  Republicans rejected legislation to cap insulin costs for millions of 
people with diabetes nationwide. Now they want to raise costs for 
seniors by repealing the cap for people who rely on Medicare. As many 
as one in four of the 7.5 million Americans depending on insulin are 
skipping or skimping on doses. I want to say that again. As many as one 
in four of the 7.5 million Americans depending on insulin are skipping 
or skimping on doses. This is a life-threatening practice. No one in 
this country should have to bear that.
  This week, we know Republicans in the Senate will make us vote on a 
budget that will, inevitably, intend to harm the strength of programs 
like Medicaid and vital health programs in general.
  Here is what a few organizations are saying about the impact of the 
budget that will soon be put on this floor, what impact it will have on 
our health systems.
  According to this nonpartisan Center on Budget and Policy Priorities, 
a nonpartisan policy and research institute, this is what they write:

       The House Republican budget would require deep cuts to 
     Medicaid, and recent statements from House Energy and 
     Commerce Committee Chair Brett Guthrie suggest the Affordable 
     Care Act's . . . Medicaid expansion to adults with low 
     incomes--which covers more than 20 million [Americans]--will 
     be a prime target. Cutting Medicaid by hundreds of billions 
     of dollars and focusing many of those cuts on the Medicaid 
     expansion would lead millions of people to become

[[Page S1935]]

     uninsured. Eliminating Medicaid expansion was a key goal of 
     Republicans' failed effort to repeal the ACA eight years ago, 
     and Congress should once again reject efforts to undermine 
     it.
       Recent Republican proposals such as reducing the federal 
     matching rate for Medicaid expansion, repealing the 2021 
     Rescue Plan's incentive for new states to expand, or taking 
     away Medicaid coverage from certain adult enrollees by 
     imposing work requirements would leave expansion enrollees at 
     risk. They could lose their coverage due to work 
     requirements, or their state might drop their coverage due to 
     a drastic increase in state costs. Twelve states--

  Twelve American States--

       have ``poison pill laws'' that would automatically end 
     expansion coverage or require review of the coverage if the 
     federal matching rate drops below 90 percent. In [those] 
     states, expansion enrollees are at even greater risk.

  [Representative] Guthrie's recent statement confirms that [House] 
Republicans are eyeing proposals such as work requirements, a reduction 
in the federal matching rate, or a per capita cap on funding for the 
expansion group. This last option could shift . . . $72 billion and 
$190 billion in costs to states from 2026 to 2034--
  Putting that burden from $72 billion to $190 billion on States--

       increasing the state costs of expansion by 41 to 108 
     percent and [thus] jeopardizing [medical] coverage for 
     millions.
       Forty states plus Washington, D.C. have adopted the 
     Medicaid expansion--

  Forty States, plus the District of Columbia have adopted the Medicaid 
expansion--

       helping adults with low incomes become healthier and more 
     financially secure. Health coverage through expansion 
     improves people's access to--

  Something that makes so much economic sense. It--

       improves people's access to preventive and primary care, 
     [it also] provides care for [people with] chronic illnesses, 
     prevents premature deaths, and protects people from 
     catastrophic out-of-pocket medical costs.

  Let me pull away from the nonpartisan group's remarks for a second 
because I saw this as a mayor. When you scrimp on regular treatment for 
people with chronic care, when you scrimp on preventing disease, it 
costs more to taxpayers. I saw that because folks would end up in my 
emergency rooms in Newark. And the care there is so much more 
expensive. For a taxpayer, you get a much better deal in helping 
someone treat their chronic disease. You get a much better deal in 
giving them regular access to doctors. But to cut that makes no sense.
  Not only are you cutting it to give, again, those larger tax cuts to 
billionaires and corporations, but you are cutting it, and you are just 
going to add more and more to the overall healthcare costs of our 
country and to the size of the debt.
  Let me go back to the text.

       Having health coverage also makes it easier for adults to 
     work or . . . look for a job. Considering that Medicaid 
     supports work and that 9 out of 10 Medicaid adults are 
     already working, caring for family, attending school, or are 
     ill or disabled, work requirements are unnecessary. [They 
     are] burdensome. [They are more redtape and hassles.] 
     Proposals to use work requirements as a way to take away 
     Medicaid coverage from certain adults are just another way to 
     undermine the Medicaid expansion.
       Attacks on the Medicaid expansion are often based on false 
     claims that covering adults with low incomes takes away care 
     from groups traditionally eligible for Medicaid. In reality, 
     Medicaid expansion supports better outcomes for all groups, 
     including children, older adults, and people with 
     disabilities.
       Medicaid expansion has driven coverage gains for parents, 
     which improves their access to care as well as [their] 
     overall well-being [the overall well-being] of their 
     children.

  Stepping away from the text, there is not a parent in America who 
knows that when you are sick, when you are being hurt by your chronic 
disease, it is harder to take care of children, and their well-being 
suffers.
  Back to the text:

       Expansion has also driven coverage gains among people with 
     disabilities. People with disabilities who receive 
     Supplemental Security [insurance] Income generally also 
     qualify for Medicaid, but 2 out of 3 people with disabilities 
     who participate in Medicaid qualify on another basis, meaning 
     Medicaid expansion is an important path to coverage for those 
     with low incomes.
       Medicaid expansion also supports hospitals and other health 
     care providers by reducing their uncompensated care costs and 
     improving their operating margins, especially [especially, 
     especially] for rural and safety-net hospitals. If all states 
     [in America] were to drop the Medicaid expansion in response 
     to a decline in federal support, a recent analysis found that 
     [the] provider revenues would fall by $80 billion and 
     uncompensated care costs would increase by $19 billion in 
     2026 [alone].

  That is the end of the article. This is not a hyperbole or scare 
tactic. These are real possibilities. Even the nonpartisan 
Congressional Budget Office has said there is no way to meet the 
Republican budget resolution dedicated cuts without cutting Medicaid or 
Medicare.
  (Mr. MORENO assumed the Chair.)
  Tonight and into tomorrow morning, I am going to do everything I can 
to elevate the voices of Republicans because this is not intended to be 
a partisan speech.
  From the Cato Institute to the Wall Street Journal, to nonpartisan 
groups, to the Congressional Budget Office, everyone is pointing to 
what is happening as not normal, not what the President says it is, as 
something that is going to hurt Americans, something that is going to 
cost us more money in the long run--that someone is going to take 
people with disabilities and put them even more in the shadows and in 
the margins when they should be centralized and empowered, that what 
they are proposing is not just morally wrong; it actually adds to the 
fiscal crisis of our country.
  It will drive up healthcare costs in America. It will drive up 
chronic disease in America, an issue so important to me that I have 
been fighting for it since I got here, because America--this great 
Nation, this great land--is one of the leading countries on the planet 
Earth, in the Western World--in the leading democracies, I should say--
that has maternal mortality rates that are extraordinarily high.
  Forty-plus percent of our babies are born on Medicaid.
  Here is an article from NBC: ``Republicans can't meet their own 
budget target without cutting Medicare or Medicaid.''

       House Republicans can't meet their own budget target that 
     is necessary to pass President Donald Trump's legislative 
     agenda without making significant cuts to Medicare or 
     Medicaid, the official budget scorekeeper confirmed 
     Wednesday.
       House Republicans adopted a budget blueprint last week that 
     opens the door to pass Trump's policy priorities on 
     immigration, energy and taxes. It instructs the House Energy 
     and Commerce Committee to cut spending under its jurisdiction 
     by $880 billion.
       The Congressional Budget Office, a nonpartisan in-house 
     think tank that referees the process, said that when Medicare 
     is set aside, the total funding under the committee's 
     jurisdiction is $8.8 trillion over 10 years. Medicaid 
     accounts for $8.2 trillion of that, or 93%.
       When Medicare and Medicaid are excluded, the committee 
     oversees a total of $581 billion in spending--much less than 
     the $880 billion target--the CBO said. The letter outlining 
     the figures was in response to a query by--

  I will step away from the article for a second--by my friend and 
longtime New Jerseyan Representative Frank Pallone--he is the ranking 
member of the Energy and Commerce Committee--and Brendan Boyle, a 
Democrat, of Pennsylvania, the ranking member of the Budget Committee. 
They asked the question.

       That leaves Republicans in a deep predicament. The budget 
     resolution, adopted by the slimmest of margins in the 
     narrowly divided House, was the delicate product of 
     negotiations among conservative hard-liners who demand steep 
     spending cuts and swing-district GOP lawmakers who say they 
     don't want to slash funding for the health programs their 
     constituents rely on.

  Off the article for a second, God bless you for caring about your 
constituents.

       Revising the target would mean upsetting one of those 
     factions and potentially risking the support of key votes to 
     pass the eventual budget reconciliation bill that advances 
     Trump's agenda.
       Democrats have made protecting Medicaid a centerpiece of 
     their attack on the party-line GOP agenda, accusing Trump of 
     trying to cut health care for the working class to pay for 
     tax cuts for the wealthy.
       ``This letter from CBO confirms what we've been saying all 
     along: the math doesn't work without devastating Medicaid 
     cuts,'' Pallone said Wednesday in a statement. ``Republicans 
     know their spin is a lie, and the truth is they have no 
     problem taking health care away from millions of Americans so 
     that the rich can get richer and pay less in taxes than they 
     already do.''

  You see--stepping away from this--they are saying we are going to 
make these cuts to balance the budget, but their budget blows a bigger 
hole in our deficit. If this is what Trump said, then why are they 
proposing to cut $880 billion from critical healthcare programs

[[Page S1936]]

like Medicaid, Medicare, and the Children's Health Insurance Program?
  You can't have it both ways. Donald Trump promised to make America 
healthy again, but gutting healthcare for millions of Americans--
gutting healthcare for millions of Americans--rolling back healthcare 
for millions of Americans, rolling back support for new mothers, 
slashing innovative cancer treatments--this doesn't help families.
  I love what Dr. King said. Martin Luther King famously stated:

       Of all the forms of inequality, injustice in health is the 
     most shocking and inhumane.
       Of all the forms of inequality, injustice in health is the 
     most shocking and inhumane.

  Paul Farmer--extraordinary leader, physician, anthropologist, 
renowned humanitarian, pioneer of global health--I read his book 
``Mountains Beyond Mountains.'' In another one of his books, 
``Pathologies of Power: Health, Human Rights, and the New War on the 
Poor,'' he wrote:

       If access to healthcare is considered a human right, who is 
     considered human enough to have that right?

  I think, in a country this wealthy, where we are seeing stratospheric 
wealth created here in individuals, we are seeing some of the richest 
people in the world, and yet we still are targeting--for tax breaks for 
them, we are targeting millions and millions of Americans who rely on 
things like Medicare.
  I started my speech with John Lewis. Let me quote him now. In 2012, 
he said:

       Healthcare is a right, and it is not a privilege, not just 
     for some people but for all people.

  John Lewis was a visionary.
  So let me tell you a bit more about Medicaid. If you are watching, 
let me break it down and show just how critical it is for millions of 
Americans.
  Medicaid, right now, is in the crosshairs of many, many Republicans 
in Congress. It is on this precipice. It is not abstract policy. It is 
not just numbers in a line item in a budget.
  At stake, when we talk about Medicare, it is millions and millions of 
Americans' health. It goes to this question: How deeply do we care for 
one another?
  I love what our Founders said in the Declaration of Independence. At 
the very end of that, they say: ``We [must] mutually pledge''--pledging 
to each other--``our Lives, our Fortunes, and our sacred Honor.
  Are we living up to that when we are saying we are going to take away 
healthcare from millions of Americans in order to have greater tax 
cuts?
  You see, people want to just say, ``Oh, it is a government program,'' 
as if that is a slur, when, really, it is something that we the people, 
in order to create a more perfect Union, created as a lifeline to tens 
of millions of Americans that, but for programs like this, would be 
succumbing to diseases, succumbing to ill health. And we as an entire 
country would suffer.
  Think about this not as that slur where they try to call this in ways 
that try to shift public opinion away from human beings, fellow 
Americans, our patriots. Think of it instead as a lifeline.
  It is the reason a child with asthma can breathe easier. It is the 
reason a senior can receive the care they need in a nursing home--our 
elders. It is the reason a low-income mother can take her child in for 
vaccinations or a person with a disability can live with dignity and 
independence.
  Congress is entertaining proposals now--conversations are being had 
in this building and in Senate and House office buildings about how we 
can gut programs.
  God, I wish somebody said: In a bipartisan way, let's come together 
and find healthcare savings. I offered that. I literally said to the 
now-Secretary of Health--I told stories about private sector folks who 
saved money by expanding access to food--to healthy, fresh food. Let's 
say that, because I know private sector companies that have bent their 
cost curves and saved money not by cutting healthcare but by giving 
people better access to nutritious, healthy foods. You are what you 
eat.
  We are not coming up with bipartisan proposals to save money, to 
create efficiencies, to do things that can make programs run better. 
Heck, when I was mayor, we were able to lower expenditures, create more 
efficiency, have more customer service. There are ways to do that.
  But no, this is folks coming with an ax to cut your healthcare or 
your neighbor's healthcare or your elder's healthcare.
  It is not a government program; it is a commitment we make to each 
other. In the greatest Nation on the planet Earth, we say we will take 
care of our children; we say we will take care of expectant mothers; we 
say we will take care of our own.
  But they passed that House budget resolution. Republicans who call 
themselves moderates or budget hawks, they all voted for it except for 
one, who had this crazy thing to do in Washington--to tell the truth. 
Massie said that, by their own numbers, this don't add up; what they 
are pushing on the American people, it is going to steal from the 
future generations by racking up trillions of debt. He stood on 
principle.
  They are not even doing what they are telling us they are going to 
do. And $880 billion in Medicaid funding cuts, that is not trimming the 
fat. It is not finding deficiencies. It is not a plan to cut out any 
possible corruption. It is to make children and expectant mothers and 
seniors and people with disabilities have a harder time accessing 
healthcare, which we already said--Martin Luther King said:

       Of all the forms of inequality, injustice in healthcare is 
     the most shocking and inhumane.

  Not bigotry, not poverty--two things he fought so nobly against--he 
said the most inhumane, the most unjust are what we are talking about 
here.
  Take away access to healthcare from children, take away access to 
healthcare from our elders, take away access to healthcare from people 
with chronic diseases. Why? Why? To cut the deficit?
  Well, there are some Republicans willing to tell the truth. It is not 
going to cut the deficit. It is to take from the poor and give it to 
the rich and powerful. Well, we know the rich and powerful will get 
bigger tax cuts.
  They are not shrinking the government, folks. They are creating 
bigger and bigger governmental obligations.
  And what do they mean when you look at 10 years out and have 
trillions and trillions and trillions of more? It means that future 
generations--or maybe 10 years from now--their debt payments are going 
to grow more and more and more, taking away more money that we have as 
a collective body, as Americans, to invest in scientific research, to 
invest in cutting-edge medical technology.
  So let's be clear. Let's be clear. Children from low-income families 
would lose access to routine checkups, vaccinations, and emergency 
care. Seniors who depend on Medicaid for long-term care, many of whom 
are already exhausting their life savings, would be left without 
options. People with disabilities who require constant medical 
attention, specialized equipment, and home-based services would face 
uncertainty and loss of those services.
  And let us not forget the low-income adults who gained coverage 
through Medicaid expansion, who worked hard every day. They got access 
to Medicaid through expansion under the Affordable Care Act. For them, 
this is not ideology. For them, this is not political philosophy. For 
them, this is life or death. It is about survival.
  These proposed cuts would also devastate the very infrastructure of 
our healthcare system.
  These proposed cuts would also devastate the very infrastructure of 
our healthcare system. I have heard this from hospitals--again, 
Republican and Democratic leaders in my State who know our hospitals 
are speaking to this injustice. Medicare provides nearly 19 percent of 
all hospital revenue. It allows rural hospitals already on the brink to 
keep their doors open--rural hospitals.
  It would take safety-net hospitals that serve uninsured and 
underinsured populations. Without Medicaid, with these cuts, these 
institutions would crumble. That is not rhetoric. I have talked to my 
safety-net hospital.
  I did an event, and I remember the fear in this hospital 
administrator's eyes who lives every day to help the poor, to help the 
uninsured. In many ways, we share a faith, and I know he believes he is 
answering the highest calling of his country and his faith to

[[Page S1937]]

help those who come with nothing because when hospitals close and when 
Medicaid staff lose their jobs, tired communities lose access to care. 
Ambulances end up having to drive farther and farther. Wait times 
increase. Lives are at risk.
  The ripple effects are vast. Schools will suffer when children with 
disabilities lose access to Medicaid support services like physical 
therapy, transportation, and mental health support. Children's 
abilities to learn and thrive is compromised. Schools in rural areas 
where Medicaid often funds onsite nurses and telehealth programs, they 
would be stripped of essential support.
  What we are witnessing is--again, don't get caught in this Washington 
parlance. This is not a normal time. This is a threat to millions of 
Americans. It is not a budgetary proposal.
  It is like the metaphorical sword of Damocles. It is people all over 
this country who are beginning to see what this really means. It is an 
economic crisis that would be rolled upon States and rural areas and 
communities and cities. It is a moral crisis that speaks to the soul of 
our Nation.
  It is a deliberate, calculated--and being calculated right now--it is 
a deliberate and calculated attack on healthcare for Americans in 
order, again, to give tax cuts to the wealthy.
  If the enhanced Federal match for Medicaid is eliminated, one of the 
things on the chopping block: States would be forced to absorb the 
difference, an estimated $80 billion every year. That is a 29-percent 
increase in State-funded Medicare spending per resident.
  To fill those holes, States would be left with impossible choices. 
Either raise taxes or slash services; education, infrastructure, public 
safety. For them, they would have to figure out where to get the money 
from, or else they would be slashing services.
  It is an unholy choice. Cutting Medicare doesn't make us stronger. It 
will weaken our economy. It will raise healthcare costs for everyone 
and push millions of Americans into crises that will ripple and radiate 
through their lives, their families' lives, their work lives.
  Hospitals will pass unpaid bills onto insured patients. Healthcare 
premiums will rise. People will delay care, omit medications, and then 
show up in emergency rooms later, more sick, and therefore more 
expensive to treat.
  And in the end, who pays for it? Who pays for this moral failure, 
this financial failure? Who pays for it? We do, the American people. 
And who gets rich on this? Well, I know the last tax cut they wanted to 
extend to the people who make the most money off this system and these 
cuts because the tax cuts they will get will be billionaires.
  And working families in America, the people who are paying insurance 
rates--hurts; it is hard; it is difficult. The people who have high 
premiums, copays--it is the rest of us that pay.
  So I want to talk about the people at risk. There are nearly 12 
million people who qualify for both Medicare and Medicaid, our Nation's 
most vulnerable. They would lose critical wraparound services, services 
like long-term care, dental care, vision, and nonemergency 
transportation services that are not luxuries for these folks, but they 
are lifelines.
  A higher share, those with both Medicaid and Medicare, have cognitive 
impairments and conditions, impairments like Alzheimer's, and God, my 
father who had dementia.
  We are a well-off family. I saw the challenges, the resources, the 
drains, the physical challenges for his primary caregiver, my mother.
  Millions of Americans, though, would rely on Medicaid, and they would 
face devastating choices; to quit their jobs to provide full care--
full-time care--or leave their loved ones while they go off to work on 
a job without the support they need.
  When it comes to Alzheimer's and dementia, I know personally you 
cannot leave someone without the care. Nursing homes may be forced to 
shut their doors and cut staffing levels to dangerous lows. In fact, 
people who can't take care of their elders, they might be going to 
nursing homes, which again, increases costs for taxpayers. Home 
healthcare services, often the only thing keeping people and their 
communities out of institutions, that would disappear.
  This would be a crisis for elder care. This would be a crisis for 
disability services. What it is: When a nation isn't taking care of its 
elders, it is a crisis of our national character.
  Medicaid also plays a profound role in the success of children and 
their well-being. Nearly half of all children in the United States are 
covered by Medicaid and CHIP. Research shows that when children have 
access to care, they are more likely to stay in school, graduate, and 
earn more as adults.
  That is not surprising to people just to think it through. It is 
true. If kids have access to healthcare, they succeed more in life. 
Medicaid helps diagnose learning disorders, treat chronic conditions, 
and ensure children don't fall behind simply because they are born in 
poverty. It is essential to the American dream, that just because you 
are poor, it shouldn't affect your destiny.

  For us to be the America of which we speak, a child born in poverty 
shouldn't have their future cut off because they can't get the 
healthcare to empower them to thrive. Talk to any school district in 
any State in any county. Those resources are necessary to help 
children.
  Medicaid pays for nearly half of the births in the United States. The 
United States, as I said earlier, has a shameful distinction of a 
massive maternal health crisis. We have the highest rate of maternal 
deaths of any high-income nation. I am going to say that again: America 
has the highest rates of maternal deaths--women dying in childbirth or 
in the days after--of any nation. A majority of these maternal deaths 
take place during that postpartum period, the days after birth.
  For years, I fought for Medicaid to provide coverage for women for up 
to 1 year postpartum instead of just 60 days. In 2022's Congress, I was 
so happy that States had the option to expand Medicaid coverage for up 
to 1 year postpartum. It was one of the solutions to this maternal 
healthcare crisis that expert after expert after expert says: Just make 
sure those women who gave birth are not knocked off of healthcare after 
2 months.
  As of this January, 49 States, plus the District of Columbia, have 
expanded postpartum Medicaid coverage past those 60 days. Hey, we are 
stepping in the right direction to show that we love our moms, we value 
those lifegivers that are mothers. We value them. But cutting Medicare 
means potentially eliminating the progress we made toward ending that 
maternal mortality crisis. There is just no justifying that in a nation 
this great and this wealthy.
  We talk so much about children and motherhood. All of us should be 
coming together about this maternal health crisis, but what is 
happening now, again, is the very program that has helped us to begin 
to address this is under attack.
  When we invest in Medicaid, we are investing in the future. Children 
will grow up to be healthier, and seniors will age with dignity in 
rural communities with limited access to healthcare and services and 
families who don't have to choose between a prescription and rent.
  This is about health, but I want to tell you, for all those doing the 
math at home, you cannot have a thriving economic engine without good 
healthcare. The two are incompatible. Widespread sickness, illness, and 
disease and people can't get their health issues covered, it takes away 
from our economic strength.
  In fact, just cutting Medicaid would cost jobs, nurse's aides, 
support staff, medical technicians. Entire communities depend on 
funding that Medicare provides. Cutting it would destabilize State 
budgets, force those impossible tradeoffs and widen the gap--widen the 
gap--between the richest in our country and the rest, a gap that is 
already widening at stunning rates.
  These cuts are not about efficiency. Don't let anybody tell you these 
cuts are about efficiency. I know a lot about making government more 
efficient. This is not about innovation. There are so many things that 
we as a country should be doing to deal with medical innovation. I will 
be the first to say: Republicans and Democrats have failed to step up 
to the 21st century and do things that really can create more 
efficiencies in our healthcare system.
  I really hope to see more bold thinkers about creating real 
efficiency. But

[[Page S1938]]

what they are doing now is not about efficiency. It is not about 
innovation. It is not about the heart priorities of Americans who know 
everything that I am saying.
  The letters I have gotten, Republicans and Democrats and Independents 
in my State, scared people--they know what this is about. Republicans 
in New Jersey who run hospitals know what this is about. This should be 
a bipartisan strategy to how do we make our society more healthy and 
less dependent on healthcare. When it comes to healthcare, heck, let's 
not do the stupid things like cutting scientific and biosciences and 
the research that often leads to medical breakthroughs.
  Let's come together and figure out how to deliver services more 
efficiently. Making Americans healthier, I don't believe them. They are 
cutting access for kids to fresh and healthy foods. They are cutting 
school lunch resources. There is a way to do this that should be 
bringing the best ideas from both sides of the aisle to deal with these 
issues, but that is not what they are doing.
  Every data point, every story, hospitals from rural areas to urban 
areas, everyone is saying the same thing to illustrate the same point: 
Medicaid is critical to the health of some of the most vulnerable 
Americans. It is critical to our elders, to our children, to our 
mothers. It is a lifeline for more than 72 million people.
  With control of the Senate, the House, and the Presidency, 
Republicans have the opportunity to dream big. They have an opportunity 
to lead with a vision for better health in America, to come before the 
people and Congress and hearings and say: This is our vision for 
American health and well-being. We are going to show what some private 
companies did. They cut their healthcare costs and improved the health 
of their employees by providing better access to food.
  There are so many good ideas that I learned when I was mayor, from 
Republicans, from private sector people, but those aren't the ideas 
coming forward. The ideas coming forward are: Hey, let's just send to 
the Energy and Commerce Committee the mandate to cut $808 billion. 
Let's rush now. Let's rush now. Let's get it done before our narrow 
majority somehow gets undermined. Let's just cut, cut, cut, cut, cut, 
and in the end, what is the result?
  Americans get sicker, driving up overall healthcare costs, all to 
give billionaires more of a tax cut.
  I know the character of so many of my friends in this body on both 
sides of the aisle. This is not who we are. It is not who we are.
  But God, there is no big vision, there is no big dream for 
healthcare. Instead of improving Medicaid and increasing funding, as 42 
percent of Americans support, they want to make extraordinary cuts that 
will demolish the program. They are proposing that $880 billion cut 
from Medicaid, taking healthcare away from millions of Americans. They 
want to impose work requirements even though 90 percent of Medicaid 
beneficiaries are already working or cannot work for legitimate 
reasons.
  Arkansas actually tried this. I love case studies. They tried this in 
2017, and the results were disastrous. People lost coverage that they 
shouldn't have, and employment didn't increase.
  Nationally, such requirements could put 36 million people at risk of 
losing their healthcare.
  They are proposing failed policies, not breakthrough ideas, not a 
bold vision that I know is in America's heart.
  This repeal that some folks are saying that they want to do to save 
money, the hatred for the previous President--they want to repeal 
Biden-era rules that made Medicaid and CHIP enrollment easier, less 
redtape, easier for seniors and children. Let's repeal that, they say.
  They want to end a rule requiring minimum staffing standards in 
nursing homes, including 24/7 access to registered nurses--one of the 
hardest, most underappreciated jobs in America. Let's give less access 
to these noble, noble professionals.
  They propose per capita caps that would upend Medicaid's financial 
model in every State, leaving States with less money to meet their 
residents' needs. In States that expanded Medicaid under the ACA, these 
cuts could jeopardize coverage for 20 million people who gained access.
  The budget that they are proposing would require deeper cuts.
  Speaker Johnson claims these changes are about rooting out fraud, 
waste, and abuse, but that is not what is happening, folks. What is 
happening is an assault on a program that provides dignity, health, and 
stability, economic growth, improved outcomes for kids, and more 
respect for our elders and care for the disabled. Nearly 2 million New 
Jerseyans, 2 million people in my State rely on Medicaid, and yet our 
State is slated to see cuts of up to $5.2 billion.
  Medicaid accounts for a quarter--more than a quarter--of New Jersey's 
State budget. Think about that. It accounts for more than a quarter of 
our State's budget. My State--one of the hardest working States that 
are out there--just their work requirement would put about 700,000 of 
my neighbors at risk of losing their healthcare.
  Medicaid covers about one-fifth of hospital spending. At University 
Hospital in Newark, New Jersey's only level I trauma center, more than 
$149 million in potential cuts loom. I know this hospital. I have been 
there when my officers have been injured. I have been there when my 
firefighters in Newark were injured. I have been there when heroic 
citizens are injured and brought there. It is our level I trauma 
center. People from all around our region are sent there. These 
emergency room workers are incredible. Heck, they have treated me 
coming out of an emergency. And they are facing $149 million in cuts. 
And their leadership, knowing how vital that hospital is, how that 
hospital stands in the breach between life and death, health and 
illness, they know what it would mean.
  We should be strengthening this program through innovations that come 
from people on both sides of the aisle. We should be coming together as 
a body and saying: OK, let's spitball this. Let's put up the best ideas 
in America to make things more efficient.
  Well, wait a minute, you mean if we treat chronic diseases with 
access to healthy food, we might actually be able to lower diabetes 
rates, lower hypertension rates, lower obesity rates? Well, that is one 
great way to make this investment happen.
  There is technology and innovation that are happening right now with 
our best scientists that could create better access to telehealth, that 
could create more efficiency in medical records, that could cut down on 
mistakes that are still made in medical care, like combining the wrong 
drugs or other challenges that drive up costs.
  There are systems that we could create that could create more 
transparency and eliminate more real fraud and go after the fraudsters 
themselves in a more efficient manner.
  There are so many things that we could do if we came together as a 
body. But what are we doing instead? Following our President that wants 
his tax cuts renewed.
  What did those tax cuts do the first time around? Most of the 
benefits went to the wealthiest people and corporations, and it drove 
trillions of dollars--the largest deficit growth that we have seen in a 
generation; rapacious, rapacious, misguided budgeting, creating bigger 
and bigger debt payments.
  I remind you that Clinton balanced the budget.
  Bush--the first President in American history that didn't call for 
the common sacrifice to go to war. We spent trillions of dollars in 
those foreign wars. And guess what he said. No common sacrifice. Only 
about 1 percent of our people will fight in those wars. I am going to 
give you a tax cut.
  Well, that makes no sense. You are going to drive up deficits that my 
children will have to pay for.
  Obama comes along, and at least he lowers deficit spending, but then 
Trump comes in and increases it by trillions of dollars on the backs of 
working Americans to give those benefits to the wealthiest.
  Now, Biden, who shrunk the deficit a bit--didn't eliminate it--still 
spent what any fiscally prudent person might say is really problematic. 
Let's not make this blindly partisan. But for anybody who would 
criticize Biden and follow Trump into what he is doing with this budget 
proposal that is going to slash healthcare for millions of Americans, 
increase the deficit by trillions and trillions of dollars, and make

[[Page S1939]]

Elon Musk richer and richer--is that your solution? It violates our 
values. It violates our national character. It violates the highest 
principles put forth by the most noble people in American history.

  I stand today--and I will not sit down for hours and hours if God 
gives me the ability to stand here--because I want to be the voices of 
Americans. I want to share their voices in this body. I want it to echo 
in history. I want it to be recorded by these extraordinary people who 
stand here every day and record my words and my colleagues' words. I 
want it to be in the Congressional Record.
  I want DeAnna's story--DeAnna's daughter is disabled, and Medicaid 
provides her with lifesaving medications, medical equipment, orthotics, 
and multiple specialists for her rare disease diagnosis. She has life-
threatening seizures and requires rescue procedures, medications, 
oxygen, CPR, and has nurses that accompany her to school and meet her 
medical needs during the day so that DeAnna can go to work.
  DeAnna is ``terrified''--she uses this word--she is ``terrified'' of 
her daughter losing her Medicaid. She is so afraid, she is literally 
talking openly about going to Canada and asking for asylum there so 
that her daughter has her healthcare needs met. That is outrageous to 
me, that an American who is fearful for their child would think about 
fleeing to Canada for better healthcare.
  Wendy and Cassie. Wendy is the mother, and she wrote about the 
threats that Medicaid cuts would pose to her daughter Cassie.
  Cassie is 32 years old. She has Rett syndrome--R-E-T-T--a rare 
neurological disorder that significantly impairs even basic motor 
functions, requiring the individual to have lifelong care and 
supervision. Without Medicaid funding, Cassie and Wendy would not be 
able to afford housing, the day program, and the prescriptions that she 
needs on a daily basis.
  Tonya and Cameron. God, Tonya uses Medicare and Medicaid to care for 
her son, her beloved child Cameron. Cameron is battling stage IV cancer 
and is confined to a wheelchair. Due to the severity of his illness, he 
cannot be without his cancer treatment and prescription medication. 
Medicare and Medicaid coverage are for them, they say, a matter of life 
and death for Cameron.
  Here is this amazing group in New Jersey, in Cherry Hill--amazing 
group--the Cherry Hill Free Clinic. Volunteers sustain the Cherry Hill 
Free Clinic, doctors who give up their own time because they are driven 
by the conviction that in America, we take care of each other, we love 
each other.
  When you say ``Love your neighbor,'' love requires sacrifice and 
service, and these doctors and professionals that volunteer their time 
at the Cherry Hill Clinic--I just want to tell you: God bless you. 
Thank you for living our American values and the values of your faith's 
traditions.
  The Cherry Hill Free Clinic provides free healthcare treatment and 
medication to low-income individuals not just in Cherry Hill but 
throughout New Jersey. Without the support of Medicare and Medicaid 
coverage for their patients, the free clinic would not be able to 
provide the extent of services and care their patients desperately 
need; they would not be able to be the source of light to so many 
people that are facing scary darkness.
  They think: That is not going to happen to me. That cancer diagnosis 
is not going to happen to me. That rare disease that affects the 
child--it is not going to happen to me.
  But when it does and they can't imagine how they will make ends meet, 
they find in the Cherry Hill Clinic doctors and medical professionals 
willing to step up. And they have been doing extraordinary things. It 
would make every American proud. And now they see what is coming from 
this Republican, from this Donald Trump proposal.
  Jeanne is an awesome soul. She is a disabled citizen. She relies on 
Medicaid coverage for her frequent hospitalizations. Without Medicaid, 
she would be unable to receive the critical care that she needs.
  God bless you, Jeanne.
  Susan writes to us. She is a disabled person who is confined to a 
wheelchair. Susan relies on Medicaid for her healthcare. Medicaid 
provides her wheelchair transportation to get her to her medical 
appointments. Without Medicaid, she would not have medical coverage or 
the transportation means to receive the essential healthcare.
  Edna. Edna. Edna is 98. God bless her--98. What a life. Now, as a 98-
year-old, she has dementia. Her daughter is 78 years old. I can't 
imagine this moment when you realize at 78 that you can't any longer 
care for your 98-year-old mom due to her worsening dementia. Edna 
receives Medicaid coverage and is now able to have full-time care at a 
rehabilitation center for senior citizens.
  Her daughter, at 78 years old, is so grateful, so grateful to live in 
a country where her 98-year-old mom can be in a rehabilitation care 
center. But they know what savage cuts in Medicaid would do.
  Randi and Dylan. Randi enrolled her son Dylan in Medicaid. Dylan is 
10. He is wheelchair-bound due to Duchenne muscular dystrophy.
  Dylan requires frequent medical care and daily heart medications to 
prevent the issues with his heart functioning.
  Randi relies on Medicaid to provide medical care for Dylan, whom 
Randi loves so much. Medicaid covers the costs and his critical 
prescription medications.
  And then there is Theresa, who recently lost her job, and required 
urgent medical assessments due to a medical issue that was discovered 
by her doctor.
  During what was a difficult time where you go to the doctor and the 
doctor discovers something that is so urgent you need immediate 
support, Theresa was without insurance and needed to receive care as 
instructed by her doctor. Due to her enrollment in Medicaid, she was 
able to receive the diagnostic testing that she needed.
  It is a good story, but stories like that have become more difficult 
if cuts are made.
  Pamela: Pamela writes that Medicaid is essential to her 22-year-old 
son's life. He has epilepsy, cerebral palsy, vision impairment, and too 
many other complex medical issues for Pam to list to us. Medicaid 
provides his health benefits and is his funding source to attend his 
day program and receive therapies. Private duty nursing comes to his 
home, and it pays for vital medications.
  She writes to me that ``Our private insurance is not enough to cover 
our son's complex medical needs. We would not be able to pay for his 
monthly prescription costs, nor the lengthy hospital stays when he is 
sick. We would not have the nursing hours to support his care to be 
able to continue to live at home, nor would we be able to leave home on 
weekdays and have a day program to attend.''
  Pamela writes:

       As his parent, I need to take an early retirement from 
     public school teaching to care for our son because the 
     medical coverage he has just isn't enough.

  It doesn't provide for his transportation and his day programs. So 
she is leaving her job early.
  She writes--and she bolds this:

       Our disabled community members and their families deserve 
     better. Medicaid provides for a bare minimum existence.

  And she has a message for the lies being told by too many. She says:

       There are no excesses here in my house.

  Sally and Mike:

       We rely on Medicaid for our two adult children with 
     disabilities for long-term care, especially for my daughter 
     who just finished her 2\1/2\-year chemo treatment regime. We 
     will need it for monthly checkups and prevention of a 
     relapse. We use the funding to provide the much-needed care 
     she needs at home.
       We also have 90-plus-year-old parents who need Medicaid in 
     order to survive. We are the real sandwich generation, caring 
     for two adult children with special needs and two very 
     elderly parents who couldn't survive on their own. Please do 
     everything in your power to help fund and not cut Medicaid in 
     any way. Thank you for your time and your commitment in 
     helping the more vulnerable population.

  I mean, Sally and Mike, you are not alone. That sandwich generation, 
taking care of children and parents. You are taking care of adult 
children and 90-plus-year-old parents. I hear you. I hear you.
  Carole:

       My son Jason is 41 and autistic. He has severe behavioral 
     issues. Medicaid has enabled my son to attend a day program 3 
     days a week. The program bills Medicaid for his

[[Page S1940]]

     participation. We would not have the financial resources to 
     pay for my son's day program. Medicaid helps us to have our 
     son living at home with his loved ones, not in a group home. 
     We save the State money by taking care of him. Do not cut--do 
     not cut--this vital program.

  Rosemari: Now, Rosemari says that she has an adult son, and that son 
has CP, a seizure disorder, cystic--this is where maybe I should have 
gone to medical school and not law school--cystic encephalomalacia. My 
cousin, the doctor is here. She would be able to help me if she was 
down here.
  But it is her son, her adult son is on the autism spectrum, yet he 
earned a BA--``yet he earned a BA on the autism spectrum and lives 
`independently' but with our support and works a part-time job.'' She 
put ``independently'' in quotes.

       If he loses his medical coverage, he would not be able to 
     afford to live where he lives and, most importantly, will not 
     be able to afford his meds. He has medications that would run 
     $500 a month. We live with the anxiety.

  We live with the anxiety. We live with that anxiety that millions of 
Americans live with; that erodes them; that burns at their spirit. That 
anxiety that has put millions of Americans in bankruptcy. That anxiety. 
That anxiety that I can't afford my medications. That anxiety that I 
can't care for my children. That anxiety that I won't have the 
resources. That anxiety.

       We live with the anxiety of Medicaid cuts, every report 
     about what House Republicans are doing. We support anything 
     that can be done to maintain Medicaid. Please, Senator.

  Danielle, she writes:

       I am the oldest sibling to my two younger brothers, Matt 
     and Christian, who have been living with a rare neuromuscular 
     disease since they were diagnosed as babies. Throughout their 
     lives, Matt and Chris, along with my parents and family, have 
     fought to ensure that they have the best care possible, 
     despite how unknown and underresearched their condition is.
       Taking Medicaid away from them would strip Matt and 
     Christian of basic access to specialized care that they rely 
     on and therefore strip them of their dignity and their 
     independence.
       As someone who has had a front row seat watching two people 
     I love suffer from a neuromuscular condition and as a human 
     being who believes in the right to access medical care, I 
     implore--

  I implore; I implore--

       our representatives and the Trump administration to 
     consider the devastating impact that these cuts would have on 
     people like my brothers. Slashing funds for an already 
     underfunded program is not only the wrong target in the name 
     of, quote, efficiency, but also a decision that would cement 
     our Nation's treacherous path toward becoming a nation that 
     does not seek--

  Does not seek--

       justice for all. Instead a nation that only serves those in 
     power, only serves the powerful, only serves the wealthy. As 
     your constituent affected by neuromuscular disease, I am 
     concerned about the potential unintended consequences of the 
     efforts to so-call reform Medicaid.

  Seventy-two million Americans rely on Medicaid for affordable 
accessible and State health coverage, including children, pregnant 
women, parents, seniors, and individuals with disabilities. Any effort 
to reform Medicaid should not inadvertently prevent patients from 
having access to the healthcare that they deserve. Danielle, I hear 
you.
  Judith: She goes right to the point.

       Please stop Trump. Please stop Trump now. He is going after 
     Medicaid. I have an adult, severely autistic granddaughter 
     who relies on Medicaid for her special needs program. She 
     writes:
       A country is judged by how it meets the needs of the 
     weakest people. Please stop him.

  I want to read your words again, Judith:

       A country is judged by how it meets the needs of its 
     weakest people.

  A country is judged by how it meets the needs of the weakest people.
  Elizabeth writes:

       Medicaid helps me access healthcare and direct supports in 
     my home, in my community. Cuts to Medicaid would mean I 
     wouldn't have the services I need to live on my own with 
     supports and would be forced to live in a more restrictive 
     setting.

  Sandra writes:

       Medicaid has allowed my son's needs to be met at home and 
     not in a group home. It has allowed my husband to participate 
     in his caregiving, not a stranger. It has allowed him to be 
     employed with the aid of a job coach.

  These are just a few things, in addition to healthcare, if the cuts 
to Medicaid happen--it goes away.
  Alicia:

       Medicaid provides healthcare and services to my 
     developmentally disabled adult child. If Medicare funding is 
     cut, my son will not have the healthcare they need and the 
     programs to attend.

  Maggie:

       My 28-year-old son Will has Down's syndrome. He currently 
     lives a full and active, inclusive life.

  His life is full. His life is active.

       He is in the community where he is cherished.

  He lives in the community. He is cherished.

       He has wonderful support staff and has lots of activities 
     that keep him healthy and happy. His days include 
     volunteering at a senior citizen center, working at the local 
     gym, shopping, leisure activities, speech therapy. He does 
     music therapy.
       We follow the self-direction model, which is work on my 
     end, but I would not have it any other way. But if Medicare 
     funding is cut, these cuts would impact his livelihood.

  Nybil:

       Without my Medicaid, I would not be able to be as mobile 
     nor independent. Without Medicaid evaluating my physical 
     disability, cerebral palsy, and related limitations and 
     prescribing me an electric power wheelchair for daily 
     independence and assistance with mobility and even pain 
     management due to not being able to walk well. I am actually 
     up for a new wheelchair this year, as it was allowable every 
     5 years for a new wheelchair prescription.
       Without my Medicaid, I would not have been properly 
     diagnosed with things like sleep apnea in 2017. I now use a 
     CPAP machine to force air into my body so I can sleep 
     peacefully instead of gasping for air at night. Without my 
     Medicaid, I would not be able to be fitted for a leg brace 
     for my physical support and mobility, enabling me to actually 
     stand up straight and walk without my wheelchair. Without my 
     Medicaid, I would not be able to be a full-time employee, a 
     full-time worker.

  Laura:

       Medicaid has provided my sister with benefits to help 
     support her medical and mental health issues since she 
     graduated high school. She is now 33 and living with me and 
     my husband after being separated from our parents that are 
     now in assisted living and nursing home arrangements.

  Wow.

       Susan has never worked or been married because of her 
     mental disability, and she is dependent on her Medicaid 
     benefits. Please keep these benefits in place for people like 
     my sister who don't have much in their lives they can depend 
     on.

  Laura, your sister is now living with you after being separated from 
your parents, who are now in a nursing home. I see you.
  Michael:

       I need Medicaid because it provides me the ability to get 
     my anxiety medication and to afford my therapist. I use 
     Medicaid for medical, dental, and visual visits. I wear 
     glasses. Without Medicaid, I am unable to live or function in 
     this world.

  Robin:

       Courtney is my 35-year-old daughter with severe 
     disabilities. From 2009 to present, she has needed crucial 
     surgeries, as well as medications and hospital stays. 
     Medicaid has made the financial support for these procedures 
     possible and to save her life.

  And I know, I can tell from her letter, that Robin loves her 35-year-
old daughter Courtney.
  Mary:

       Medicaid is helping to improve my daughter's life through 
     the services of the Division of Developmental Disabilities. 
     Without it, she would be left to whittle away at home 7 days 
     a week with no community interaction. She is learning 
     prevocational skills in a manner that she is validated and 
     viewed as a person with strengths.

  Thank you, Mary.
  Allison:

       I am my daughter's caregiver in New Jersey. Medicaid-funded 
     programs allow her to remain an active part of our community 
     at home with her family. If Medicaid is cut, we would lose 
     our healthcare. It would be devastating.

  Gihan:

       My daughter has a disability. Through Medicaid, she 
     receives a lot of services that help her improve and 
     progress. Also, to help her stay active and social, she gets 
     speech therapy, occupational and physical therapy. People 
     come to our home to help her as well. If Medicaid cuts 
     happen, she will stop all the services she receives, and her 
     life will be threatened. Please, she must keep her Medicaid 
     because, as a parent, I don't know what I can do with my 
     daughter if that is happening. It will be so hard for her and 
     us.

  Roseanne:

       Medicaid has supplied the nurses that take care of my 
     disabled granddaughter that I am raising at home, instead of 
     being sent to an institution. She will put her life at risk 
     for a medical emergency or fatal injury without nurses here.

  Ash:


[[Page S1941]]


  

       My daughter takes speech therapy, occupational and physical 
     therapy, and tutoring. So if that is all gone, she will stop 
     progress, and she will be more disabled and will be unable to 
     do anything by herself or live inadvertently. She needs a lot 
     of help. And if these Medicaid cuts happen, I don't know what 
     I will do with her, and it will make life so hard.

  These Americans are facing challenges that I can't imagine. And what 
is amazing about so many of them is they find the goodness and the 
decency of their neighbors, of people who are helping and supporting 
them, of people who do the jobs, the occupations that many Americans 
would find incredibly challenging--the occupational therapist, the 
physical therapist, the person who does the transportation, the nurses 
that take care of folks. It is a community of people out there that are 
trying to make our Nation stand for what we say we do. They are trying 
to show that we are a loving and caring and compassionate community.
  And what I love is that this is not partisan. I keep saying this over 
and over again for this whole time I can stand. I hope it is as many 
hours as possible. I am going to be bringing in the voices of 
Republicans and Democrats because it is not a partisan issue. Maybe it 
is in Congress, but the Republicans and Democrats of America don't want 
Medicaid cuts. They especially don't want them to benefit the richest 
amongst us, who don't need more help. God bless them. They are doing 
all right.
  And it is not going to solve our budget problems. Their budget 
proposal, as was said by the one lone Republican who voted against it 
because he is such a fiscal hawk--he said: If you just read their own 
numbers, this is a lie, a sham. It increases the deficit by trillions.
  Let me go to some Republicans.
  Joe Lombardo, the Governor of Nevada:

       An abrupt reduction in federal funding would not only 
     disrupt care of those who rely on Medicaid, but would also 
     destabilize public and private healthcare providers, leading 
     to workforce reductions, service limitations, and financial 
     strain on already overburdened health care facilities.

  The Governor of Nevada knows that my mom, my aunt, my uncle, my other 
aunt--they live in Nevada. My mom lives in a retirement community 
there. This Governor knows that that State would be hit so hard by a 
reduction of these services that it would be like an impact that 
ripples out throughout the State, raising costs, lowering care, hurting 
Americans, hurting Nevadans.
  My colleague Mike Rounds of South Dakota said:

       That is not a cost-cutting measure--that's a cost transfer.

  He said:

       And when you've got partnerships with the states, you 
     shouldn't be doing that without having them involved in the 
     discussion.

  I tell you, I have conversations with lots of my Republican 
colleagues, and I appreciate this quote from one of them.
  The Coalition of State Medical Associations writes:

       On behalf of 50 state medical associations and the District 
     of Columbia, the hundreds of thousands of physicians we 
     represent--

  I am adding this. I am sure of both political parties and 
Independents.
  Back to what they write:

       --and the 80 million Medicaid patients we serve, we are 
     united in urging the U.S. [Senate] . . . to protect Medicaid 
     from the devastating $880 billion [cuts] . . . in spending 
     reduction target in the House Budget Resolution.
       If these cuts are enacted millions of Medicaid patients 
     will lose their coverage and we expect all Medicaid patients 
     to lose some of their existing benefits--

  ``All Medicaid patients''--``all Medicaid patients to lose some of 
their existing benefits''--

       and access to essential healthcare services.

  The American Academy of Pediatrics, Children's Defense Fund, 
Children's Hospital Association, Family Voices National, First Focus 
Campaign for Children, March of Dimes, and National Association of 
Pediatric Nurse Practitioners--they all came together to jointly write:

       By reducing vital support from Medicaid and CHIP, you would 
     not just be cutting a budget line--you would be eliminating 
     the health prospects of our children, leaving them without 
the care they need to grow into healthy adults.

  AARP:

       More than half of all the funds for long-term care in 
     America come from Medicaid. As our country gets older, and as 
     millions of Baby Boomers continue to age, our country is on 
     the brink of a serious long-term care crisis.
       AARP would welcome the long-overdue debate about how to 
     address this challenge, which should involve reforms to 
     remove Medicaid's bias toward institutional care and 
     increased support for families who take care of their loved 
     ones at home. Large-scale cuts, however, threaten millions of 
     seniors with disruption to the care they need.

  Listen to AARP: ``We would welcome the long-overdue debate''--``We 
would welcome the long overdue debate on how to address this 
challenge.''
  But we are not having a long-overdue debate. We are not bringing 
together the world's most deliberative body to focus on how to solve 
these problems.
  Michael Tuffin, the president and CEO of AHIP, America's Health 
Insurance Plans:

       Medicaid is indispensable to low-income people and working 
     families. If their Medicaid coverage is disrupted, these 
     Americans will lose access to primary care and be unable to 
     fill prescriptions for drugs to treat chronic illnesses. Many 
     will end up in the emergency room, the costliest site of 
     care. Loss of Medicaid coverage means people will be less 
     healthy and their care will ultimately cost more.

  Rick Pollack, president and CEO of the American Hospital Association:

       On behalf of the hospitals, nurses, doctors and those who 
     care for and serve the needs of 72 million patients that rely 
     on Medicaid, we urge you to consider the implications of 
     hinging the budget reconciliation bill's fate on removing 
     health care access for millions of our nation's patients. 
     These are hardworking families, children, seniors, veterans, 
     and disabled individuals who rely on essential care services.
       We ask the House to construct a path forward that protects 
     Medicaid from [these] harmful cuts that would impact the 
     access to care for millions of Americans.

  We did Republican Governors. Here is a Democrat. Colorado Governor 
Jared Polis joined with Oklahoma Governor Kevin Stitt. They are the 
chair and vice chair of the National Governors Association--Democrat 
and Republican--and they write:

       Without consultation and proper planning, Congressionally 
     proposed reductions to Medicaid would impact state budgets, 
     rural hospitals and health care service providers. It is 
     necessary for Governors to have a seat at the table when 
     discussing any reforms and cuts to Medicaid funding. States 
     and territories should be afforded more flexibility when it 
     comes to administering these programs in a manner that best 
     suits the need of [their States].

  What a radical thing that a Republican and a Democratic Governor are 
simply asking for a seat at the table in the conversation. What is the 
table? Is there a hearing? Are there discussions? Did we form a 
national commission? None of that. None of that. And they warn about 
what it will mean to their States.
  The American Academy of Family Physicians, American Academy of 
Pediatrics, the American College of Gynecology, the American College of 
Physicians, the American Psychiatric Association, all together write:

       Our organizations, representing more than 400,000 
     physicians who serve millions of patients, are alarmed by 
     proposals to implement cuts or other structural changes to 
     Medicaid during the budget reconciliation process. Cuts to 
     Medicaid will have grave consequences for patients, 
     communities and the entire health care system.

  Lisa Lacasse, president of the American Cancer Society Cancer Action 
Network:

       ACS CAN opposes cuts that will increase the number of 
     uninsured nationwide by severing the lifeline that Medicaid 
     provides for cancer patients and those at risk for cancer. It 
     is imperative for cancer patients and millions more at risk 
     that this valuable health insurance program be protected for 
     decades. ACS CAN has advocated in support of Medicaid and we 
     will continue to advocate at the federal and state levels in 
     support of expansion of access to the program and against 
     policies that jeopardize individuals' access to lifesaving 
     health insurance coverage.

  Bruce Siegel, president and CEO of America's Essential Hospitals:

       This budget resolution will open the door to devastating 
     Medicaid cuts that will impact millions of Americans, 
     especially those middle-to-low-income working Americans in 
     both rural and urban communities, who rely on Medicaid access 
     to critical health care services.

  This budget resolution and its directive to the House Energy and 
Commerce Committee to cut $880 billion of federal spending will slash 
the Medicaid Program and threaten to discontinue lifesaving, safety-net 
services in many communities.
  Thirty-eight national parents organizations--I didn't know there were 
38

[[Page S1942]]

national parents organizations. But they wrote in a chorus of 
conviction:

       Cuts on this magnitude would require enormous changes--such 
     as instituting per capita caps, reducing the federal match 
     rate for Medicaid expansion, adding barriers to coverage 
     including work reporting requirements, and repealing rules 
     that strengthen enrollment processes and access to care in 
     Medicaid--that would severely harm many individuals fighting 
     serious and chronic health conditions. Our organizations--

  All 38 national parents organizations--

     oppose any cuts to either traditional or Medicaid expansion 
     that take away coverage, jeopardize access to services and 
     providers, shift costs to states and reduce patients' access 
     to care.

  Here is a huge group that includes the National Alliance on Mental 
Illness, the March of Dimes, the Muscular Dystrophy Association, the 
National Cancer Coalition, the National Health Council, the National 
Kidney Foundation, the National Multiple Sclerosis Society, the 
National Organization for Rare Disorders. It is about--and I will 
estimate and give it to the Congressional Record--325 or 330 
organizations.

       On behalf of the undersigned chapters of the American 
     Academy of Family Physicians, representing over 130,000 
     family physicians and medical students across the country, we 
     write to convey our deep concerns regarding proposals to 
     reduce Medicaid funding or implement further eligibility 
     restrictions. We strongly urge you and your colleagues to 
     reject any reforms that have the potential to impede access 
     to essential care for millions of Americans who rely on 
     Medicaid, including our Nation's most vulnerable populations.

  Mr. SCHUMER. Would my colleague yield for a question?
  Mr. BOOKER. I would yield specifically for a question, yes.
  Mr. SCHUMER. Thank you.
  I first want to thank my colleague for taking the floor and showing 
the American people how horrible this administration is treating 
average families--working families--in so many ways, and I know he 
intends to hold the floor for a long time to make sure that that is the 
case in letting America know how bad this is.
  Now, our healthcare is the main focus right now, and it is amazing, I 
would say to my colleague: Isn't it incredible that all of these cuts 
they are proposing in healthcare are done with a purpose in mind, and 
that is to reduce the taxes on billionaires? Doesn't it bother my 
colleague that these people whom he has been documenting who so 
desperately need healthcare are going to lose that if our Republican 
colleagues have their way simply to cut taxes for the very wealthy?
  That is my question.
  Mr. BOOKER. To my leader, Leader Schumer, I mean, that is the pain of 
these stories from the families that I read of the fear that they have 
to rely on these lifelines that are going to be cut and of the services 
that are going to be cut that are going to affect their beloved parents 
or their children with disabilities.
  When they ask the question, Why? Is it for a noble purpose? Is it for 
collective sacrifice? No. The answer that they have to stare at is that 
you are going to cut services for my vulnerable child or for my parents 
in order to give tax cuts to the wealthiest Americans, in order to give 
tax cuts to the billionaires.
  Here is the insult added to that injury: It is also this lie that we 
are going to be focused on the fiscal strength of our Nation. They are 
going to give all those tax cuts away and give away healthcare 
benefits, and the results are going to be even bigger deficits. So 
people like Elon Musk and Donald Trump--billionaires, where most of 
these tax cuts will accrue to their benefit--will get more, more, more 
money. And if you were spending $100,000 a week for the rest of your 
life, you wouldn't get near the net worth of Elon Musk.
  Mr. SCHUMER. Would my colleague continue to yield for another 
question?
  Mr. BOOKER. Yes. Yes.
  Mr. SCHUMER. From what I understand--and tell me if this is correct--
if they did this tricky thing that even our Republican colleagues are 
calling fakery and hocus-pocus, our conservative Republican colleagues, 
it might increase the deficit by $30 trillion; is that accurate?
  Mr. BOOKER. That is accurate.
  It is stunning that they know that they can't do this, so they are 
going to use some budget trickery to mask the truth. Math doesn't lie. 
Numbers don't lie. You may be able to mask it so you could use rules of 
reconciliation and try to force it through, but the result for the 
American people is going to be the same.
  Chuck, people will lose healthcare, healthcare benefits, and watch 
the deficit of this Nation not increase but explode, which means the 
cost of our debt payments alone are going to be more than the very 
programs that they are going to be slashing for families. That is 
outrageous, cruel, unacceptable, and we have to do everything we can as 
a people to stop it.
  Mr. SCHUMER. Would the Senator yield for another question?
  Mr. BOOKER. Yes, sir.
  Mr. SCHUMER. Despite this fiscal hocus-pocus, this fakery, this 
trickery which my colleague has alluded to, when they cut Medicaid, 
when they cut Social Security, when they cut Medicare, those cuts 
remain just as devastating--is that accurate?--no matter what kind of 
bunk they put on their balance sheets to say it doesn't matter.
  Mr. BOOKER. I was reading stories, and many of them will live with 
me. There is a family who is taking care of their two parents in their 
nineties and their disabled adult children. They are desperately 
relying on these programs. No matter what you do or say or call it or 
label you slap on it, those are the kinds of Americans who are stepping 
up to take care of their loved ones who will get hurt.
  Mr. SCHUMER. Will my colleague yield again?
  Mr. BOOKER. Yes.
  Mr. SCHUMER. So, just today, I visited a nursing home on Staten 
Island and a nursing home on Long Island--both in Republican 
congressional districts--and I spoke to people there.
  At the nursing home I visited, if Medicaid were cut significantly, 
the nursing home would close, according to the head of this nursing 
home. He was there. Three hundred people would lose their jobs, and 
these people--hundreds of people in this nursing home--would have 
nowhere to go. Isn't it accurate that they say, ``Oh, they can move in 
with their kids''?
  First, isn't it accurate that many of them are in a condition where 
the kids can't take care of them?
  Second, given the housing shortages we face--and the tariffs will 
make that worse with the wood--isn't it true that many families just 
don't have room to take an elderly person, particularly one who needs 
care, into their homes and that this would cause chaos to all sorts of 
people who are not on Medicaid themselves but who have loved ones who 
need it in assisted living, in nursing homes, in care facilities?
  Mr. BOOKER. Yes, Senator Schumer.
  To tell a family to just double up or triple up drives up their 
costs. It is often that the elder who is living with them who might 
have dementia demands care. So the family member who is caring for them 
has to decide, Oh, my God. Am I going to give up my job, which I need 
to pay the rent? Am I going to stay home to take care of them or go to 
the job and let really difficult things happen? This is the thing that 
the leader is pointing out that, I think, is really important.
  Mr. SCHUMER. One final question.
  Mr. BOOKER. Yes, please.
  Mr. SCHUMER. Share something personal with us. You are taking the 
floor tonight to bring up all these inequities that will hurt people--
that will so hurt the middle class, that will so hurt poor people--that 
will hurt America, that will hurt our fiscal condition as you have 
documented. Just give us a little inkling. Give us a little feeling for 
the strength and conviction that drives you to do this unusual taking 
of the floor for a long time to let the people know how bad these 
things are going to be.
  Mr. BOOKER. I appreciate the Democratic leader's question.
  I think that all 100 of us in this body are getting what I have 
gotten. I can't go to the grocery store. I can't walk my neighborhood. 
I just did a travel around the country to do what a lot of us elected 
officials do, and I got stopped in the airport by people who want to 
tell me stories about a parent with dementia or a disabled child or a 
child with a rare disease who has seizures. It is story after story 
after story.
  There are people who have been writing in to me, some of them on 
scraps of

[[Page S1943]]

paper, just to try to tell us: Please--they are not saying don't do 
$880 billion in cuts; they say any diminution of resources. They live 
on such a precipice that any diminution of resources would drive their 
families into crisis and despair. Many of the professionals I am 
quoting are saying: We don't need to be cutting. We need to be finding 
ways to extend services to do more. How can we do more?

  I talked earlier about the fact--and you helped with this, Senator 
Schumer, when we were battling, many of us, and I know my friend Lisa 
Blunt Rochester was a leader in the House when we said: Why are so many 
women dying in childbirth in a postpartum period in America? It is 
shameful that we are the worst Nation of all the wealthy nations, and 
that is for us as a whole, but for Black women, it is almost four times 
as much.
  So what do we do here, Chuck? You remember this. Excuse me. Senator 
Schumer, what do we do here?
  Mr. SCHUMER. ``Chuck'' is OK.
  Mr. BOOKER. ``Chuck'' is OK.
  We came together, and we said: This is a time for Medicaid expansion. 
It was to say to a woman: You don't just get 60 days postpartum; we are 
going to expand that beyond 60 days. State after State--red and blue 
States--said: You are right. This is a crisis. That which should be the 
happiest period of a woman's life is the most devastating with women 
hemorrhaging and dying. We began to treat that.
  Now what is the threat? The threat is that they are going to cut 
these things that we did to help more people, to stop more folks from 
dying.
  And here is the trick: You know this battle well. I wasn't here, 
Chuck. You were here, and I know my chief of staff was on your staff, 
writing this in. This is why you all said: We are going to try to 
incentivize States to expand Medicare. We are going to cover 90 percent 
of the costs.
  I still don't understand why some States--talk about cutting off your 
nose to spite your face--said no. In my State, the Republican Governor 
said: Heck, yes. Sign New Jersey up. But many of those States have this 
automatic trigger that if the funding is cut--even if they say we are 
not going to cut $880 billion, just $250 billion--well, that is going 
to trigger many States to give up that Medicare expansion and go back 
to the days where millions upon millions of Americans don't have 
coverage at all.
  So, again, this whole speech is because, Chuck--Senator Schumer--it 
has been business as usual in this place when that kind of threat has 
been happening; that of the stories that I read that I had to struggle 
through. We should be doing hearings. We should be bringing in the 
people. I know the values that we share on both sides of the aisle. How 
could we be so abjectly cruel, and why? To push through a tax break 
plan from which families in the neighborhood I live won't see the 
benefits.
  Mr. SCHUMER. So I thank my colleague for his strength, his courage, 
and his effectiveness in letting the American people know how badly 
this upcoming bill will affect them if our Republican colleagues insist 
on passing it.
  Finally, I yield the floor back to him, and I thank him for his 
courage and strength and effectiveness.
  Mr. BOOKER. Thank you for allowing me to yield the floor for you to 
ask a question.
  I see my colleague here from Delaware. I am going to read a few more 
stories, but I suspect that she, too, has a question because she and I 
did not just meet when she was sworn in here in January. God bless her. 
She is my colleague, but she is my sister, and she has inspired me for 
years.
  When she heard I was doing this--and I am not sure how much this is 
done on the Senate floor--my sister came over and prayed with me that I 
could stand for a long time because she knew what we were trying to do, 
which was to try to create--with whom we served--John Lewis-type good 
trouble in this institution, to not do things as normal, and to begin 
to say that the voices I am reading are of Democrats and Republicans. 
The voices I am reading are of Democratic and Republican Governors, of 
Democratic and Republican heads of hospitals, of Democratic and 
Republican heads of medical associations, of Democratic and Republican 
constituencies. This is not right or left. This is right or wrong.
  My colleague--my colleague--I am going to put her on blast, but God 
bless your friends who remind you of who you are when you forget. She 
didn't know that I really wanted to give a speech that was speaking to 
all of America, but she came up here, and when we were praying, she 
said: I pray that you speak words of love because she and I know love 
is ferocious. It is the strongest force on the Earth. It is not soft. 
She asked God to give me words of love today.
  So I know that this friend of mine--my sister here, my colleague--
whom I have worked with for years and years and years, asked me if she 
could come to the floor and ask a question. So, as I am instructed to 
do, if you were asking me to yield for a question, then I am going to 
say: Go ahead if you want to ask me.
  Ms. BLUNT ROCHESTER. I would ask my colleague, the great Senator from 
the State of New Jersey, if he would yield the floor.
  Mr. BOOKER. I will yield for a question. I yield for a question while 
retaining the floor.
  Ms. BLUNT ROCHESTER. I want to begin by thanking you so much, Senator 
Booker, for your leadership, and thank you for the opportunity to ask 
you a question.
  As I stood and listened to you, I was reminded of why we are in this 
place in the first place. I see my colleague--the Presiding Officer, a 
member of my class--and I think one of the key things that you talked 
about was ensuring that we recognize that we are all in this together. 
I think it was even Martin Luther King who said we may have come over 
on different ships, but we are all in the same boat now. We may have 
come over on different ships. I feel like, in this very present moment, 
we have to recognize we are all in this together.
  And, to your point, when we think about the importance of Medicaid to 
this country, a lot of people don't even realize that they are on 
Medicaid. They might think of a health program that they are on, but 
they don't even make the connection with the fact that they are on 
Medicaid and that almost half of the babies in this country are born 
because of Medicaid. And it is not just from birth; it goes all the way 
to seniors who are aging with dignity because they have access to 
Medicaid, and it is allowing their family members to go to work because 
they don't have to worry about that family member. And so I wanted to, 
No. 1--in addition to asking my question--say thank you to you for not 
only shining a light on these potentially dangerous cuts but also 
ringing the alarm.

  It is alarming that we are faced with this kind of question of do we 
take money from those who are in need and are connected--because we are 
all connected--and give it to a few.
  As I think about our work on maternal mortality and how we are trying 
to make sure that our country is not only one of the richest in the 
world but the lowest in our maternal mortality numbers, as we look at 
issues of families who might have a family member who has a special 
needs child, or when I went home on our recess break, I was able to 
meet with folks from our developmental disability council. I heard a 
gentleman named Emmanuel. He is a wheelchair user. He said to me 
something that just stuck. He said: If you pull the thread of Medicaid 
out of my life, it will unravel.
  He had been sleeping in his car before Medicaid. He wasn't sure if he 
was going to have employment before Medicaid. And even he and his wife 
thought about what impact it might have, whether they were able to stay 
married or whether he would have to go into a facility.
  So I want to thank you for shining the light and ringing the alarm. 
And I want to ask you, what do you think will be the impact on children 
in this country without Medicaid?
  Mr. BOOKER. I am so grateful for that question. It sobers me when you 
ask it because just a reduction in Medicaid--I love that metaphor use--
is pulling a string out for families who are barely holding it together 
right now--families with children with disabilities or who are 
developmentally disabled who have been struggling so much to get their 
children into programs that could help move them--some of them to 
independence, some of

[[Page S1944]]

them into adulthood where they can get jobs. So many of these things 
that help to propel these children would be undermined. Just 
transportation services going away would create hardship and 
devastation on families.
  So here we are in America, when costs are going up, housing is going 
up; we are about to have these awful tariffs where the price of 
vehicles will go up, the price of transportation will go up. So the 
ripple effect of an impact on children, just by a fraction of the cuts 
that they are proposing--not to mention the grandeur of the $880 
billion--would have a devastating impact on millions and millions of 
children.
  But it doesn't stop there. You quoted King. King said in the letter 
from the Birmingham jail:

       We are all caught in an inescapable network of mutuality, 
     tied in a single garment of destiny.

  To think that there could be an injury to their family and their 
child and have it not affect you is not only self-defeating ignorance, 
it is callous and uncaring, and it demands us to step up for those 
children that you so rightfully asked me about in your question.
  Ms. BLUNT ROCHESTER. Would the gentleman yield for another question?
  Mr. BOOKER. I will definitely yield for a question while retaining 
the floor.
  Ms. BLUNT ROCHESTER. As the former executive of a city, a major city 
in this country, can you talk a little bit about the impact that these 
cuts will have on cities, municipalities, and States, because some 
might think: Oh, this is just a nice issue? No, this is an economic 
issue as well. If you can talk a little bit about the impact that this 
is going to have and why mayors across this country should care, why 
Governors across this country should care, and city councils. Why 
should they care?
  Mr. BOOKER. Well, that is the thing that is so significant. Already, 
Governors and mayors are writing letters and speaking up.
  When I go to different cities in New Jersey, I am often called by 
local leaders because they know, No. 1, the stories of the people who 
rely on Medicaid--the seniors, the children, the disabled families. But 
more importantly than that, they know their hospitals who already have 
very fragile budgets, to carve out millions and millions of dollars, as 
I said, over tens of millions of dollars for our level 1 trauma 
hospital in New Jersey, that would devastate the entire economic model 
for our hospital. It would affect jobs. It would affect the economy. It 
would affect small businesses. It would be devastating.
  Ms. BLUNT ROCHESTER. I will end my questions at the moment by saying, 
again, thank you so much, Senator Booker, for your leadership. We have 
had an opportunity to work on food as medicine--
  Mr. BOOKER. Yes.
  Ms. BLUNT ROCHESTER.--maternal mortality. There are so many more 
important things to work on. But the fact that you are spending your 
time, your energy, and your intellect to stand up for millions of 
Americans, I commend you for that. I am grateful to serve with you.
  I had the opportunity to serve with John Lewis in the House and get 
in good trouble, and I am glad to be here with you in the Senate.
  I yield back.
  Mr. BOOKER. Thank you. Thank you very much.
  I am going to continue elevating here, throughout the hours and hours 
of my speech, the voices of Americans from all backgrounds, all 
geographies, elevating the stories of leaders--Democrat, Republican, 
and Independent.
  I want to start with Matthew Cook, who is the president and CEO of 
Children's Hospital Association. Matthew Cook writes:

       The House budget resolution directive to the Energy and 
     Commerce Committee to cut 880 billion in spending will almost 
     certainly lead to deep reductions in Medicaid funding for 
     children who rely on the program and destabilize the 
     financial viability of the providers caring for them.

  To the point that my colleague from Delaware asked:

       Slashing funding would mean fewer healthcare providers, 
     fewer services, and longer wait times for patients who 
     already--

  Who already--

     face significant barriers to care. These cuts will impact the 
     37 million children on the Medicaid Program, including the 
     nearly 50 percent of children with special healthcare needs.
       Three million children in military-connected families--

  I am going to repeat that.

       Three million children in military-connected families, more 
     than 40 percent of the children living in rural areas and 
     small towns, patients in rural communities would be hit 
     especially hard as hospitals and clinics in these areas rely 
     heavily on Medicare funding to stay open.

  Here is a letter from the Mental Health Liaison Group:

       In the midst of our Nation's ongoing mental health crisis--

  I am going to pause there. When I ran for President and moved around 
the country, in townhall meeting after townhall meeting after townhall 
meeting, I was even surprised with how many Americans--I don't think we 
had a townhall where someone didn't want to stand up and tell me about 
the mental health crisis in America and how poorly we were doing. So 
when the Mental Health Liaison Group starts off with that, it hits me 
very hard.

  I still remember meeting with a guy in a New Jersey diner who had 
mental health issues, was a teacher in a high school, and he stabilized 
his mental health because of his prescription drugs but then stopped 
being able to afford them, started skimping on the drugs, had a mental 
health crisis, lost his job, and his whole life destabilized. Just 
because of not being able to have access to a costly prescription drug, 
a valued teacher had his life upended.
  I start this letter again:

       In the midst of our Nation's ongoing mental health crisis, 
     including its devastating impact on youth and our ongoing 
     overdose epidemic, it is paramount that access to lifesaving 
     MHSUD services is not reduced and the integrity of the 
     Medicaid Program to serve as a vital Federal and State 
     partner safety net is preserved. Limiting access to Medicaid 
     threatens to undermine gains in reducing overdose mortality 
     rates and could lead to increasing rates of incarceration and 
     hospitalization.

  My colleague from Delaware knows this. The biggest mental health 
institutions in America--the biggest ones--pick your State, from 
Illinois to Los Angeles, the biggest mental health institutions are Los 
Angeles prisons, are Chicago's prisons and jails, wasting taxpayer 
dollars. Where folks got their mental health treatment, their lives 
could stabilize. They could be workers. They could be helpers. They 
could not be sick.
  Here is Chip Kahn, the CEO of the Federation of American Hospitals:

       Key Republican lawmakers recognizing that so many 
     constituents rely on Medicaid for critical care made it clear 
     that their vote today was based on an understanding that the 
     final reconciliation bill would not include devastating cuts 
     or changes. I believe that is gratifying.

  Chip Kahn writes:

       It is important that these members came to the same 
     conclusion. Medicaid cuts should be off the table.

  Medicaid cuts should be off the table.

       It is up to these lawmakers to follow through and ensure 
     spending cuts don't come at the expense of care for over 70 
     million Americans, including kids, seniors, and hard-working 
     families.

  I love the appeal in that letter because it was an appeal that I am 
reminded of when my colleagues Lisa Murkowski and the great John McCain 
and an extraordinary friend Susan Collins when they voted to save the 
Affordable Care Act. They listened to the appeal of people like this 
gentleman.
  My colleague sitting there, it is like, often, we resort to words of 
vicious cruelty. John Lewis didn't do that when he advocated against 
the most horrific racists. He didn't take on words of hate. We have got 
to appeal to colleagues of good conscience, not to let--as this person 
says, no Medicaid cuts; no Medicaid cuts.
  I know President Trump has said that Medicaid cuts are off the table. 
He said that over and over and over again. We will see. We will see.
  Modern Medicaid Alliance:

       With over 70 million children, seniors, and hard-working 
     families who are relying on Medicaid for their health and 
     well-being, it is critical Congress listens to State and 
     local government officials, faith leaders, healthcare 
     providers, and hard-working Americans, and blocks proposed 
     cuts to the program.
       As organizations representing and caring for the millions 
     of Americans who receive coverage and benefits through 
     Medicaid, we know firsthand how the current level of cuts 
     being considered by Congress would impact

[[Page S1945]]

     their care. They will cause Americans to lose coverage, 
     reduce health access, and increase costs. We oppose any 
     cuts--

  We oppose any cuts.

       We oppose any cuts or harmful policy changes to Americans' 
     Medicaid benefits as part of the budget reconciliation 
     process and call on congressional leaders to reverse course 
     and protect the program moving forward.

  Here is the Modern Medicaid Alliance:

       The latest House vote breaks a vital promise to more than 
     70 million Americans who depend on the Medicaid Program and 
     now face the potential for unprecedented, destabilizing cuts 
     to their coverage and access to care. The full extent of cuts 
     being considered go far beyond addressing ``waste, fraud and 
     abuse'' and would undermine Medicaid coverage for those who 
     depend on it. Already, Senators are issuing stark warnings 
     about the impact of Medicaid cuts on the stability of their 
     communities, State budgets, hospitals and providers. We urge 
     members of the House and Senate to block any Medicaid cuts or 
     harmful policy proposals as part of the ongoing budget 
     process.

  Sister Mary Haddad, President and CEO of Catholic Health Association:

       We are deeply concerned that the budget resolution would 
     force the House Energy and Commerce Committee to slash $880 
     billion from the Medicaid Program, an essential healthcare 
     program for nearly 80 million low-income Americans. Medicaid 
     provides coverage for one in five individuals, funds 41 
     percent of all national births, and is the largest payor for 
     long-term care and behavioral health services. These cuts 
     would have devastating consequences, particularly for those 
     in small towns and rural communities, where Medicaid is often 
     the primary source of health coverage.
       Medicaid is not just a health program; it is a lifeline. It 
     provides access to care for those who need it most--poor and 
     vulnerable children, pregnant women, elderly adults, and 
     disabled individuals in our Nation--while ensuring their 
     dignity. Their dignity.

  Here is the Partnership for Medicaid again:

       The Partnership for Medicaid, a nonpartisan nationwide 
     organization representing clinicians, healthcare providers, 
     safety-net health plans, and counties, calls on Congress to 
     reject cuts to Medicaid during the budget reconciliation 
     process. The Partnership for Medicaid stands ready to work 
     with policymakers to identify more sustainable strategies to 
     strengthen Medicaid and improve upon its promise of providing 
     high-quality coverage and access to care populations.

  So this is another organization saying: Hey, put me in. Let us help 
you improve this program, and maybe we can achieve some of our mutual 
goals.
  Here is Susan Kressly, president of the American Academy of 
Pediatrics, the great AAP:

       The American Academy of Pediatrics urges lawmakers to 
     reject the budget resolution before the U.S. House of 
     Representatives and to protect programs that are vital to the 
     health and well-being of children. We oppose the proposed 
     funding cuts to programs like Medicaid and the Children's 
     Health Insurance Program, which cover nearly half of all U.S. 
     children, as well as the Supplemental Nutrition Assistance 
     Program. These cuts would have devastating consequences for 
     children and families.

  We are going to talk about cuts to SNAP later, but I love how Dr. 
Susan Kressly, president of the American Academy of Pediatrics, can't 
help but mention them together. Why is a doctor concerned about 
healthcare also mentioning SNAP? Well, fundamental to our children's 
health and well-being is having access to fresh and healthy foods.
  This is me being a little critical of people saying they are MAHA--
Make America Healthy Again--and then immediately cutting kids' access 
to fresh, healthy fruits and vegetables.
  I love this doctor. It is almost like you are doubling down on the 
injury to our children. We are cheapening highly processed and sugar-
filled, nutritionally empty foods, denying access to fresh, healthy 
fruits and vegetables, and then not letting people with chronic 
diseases get healthcare. I love this doctor for pointing out those 
connections.
  Now I am going to go to Brian Connell, who is the vice president of 
the Leukemia & Lymphoma Society:

       The fiscal year 2025 budget resolution would create not 
     just the opportunity but the obligation for the House 
     Committee on Energy and Commerce to make dangerous cuts--

  Dangerous cuts--

     to the Medicaid program in the budget reconciliation process 
     expected in the coming week. The hundreds of billions of 
     dollars of cuts demanded by the budget resolution cannot be 
     achieved without slashing benefits for enrollees or 
     altogether taking away Medicaid coverage for millions of 
     Americans.
       To be clear, the Leukemia & Lymphoma Society and the 
     patients we represent are clamoring for Congress to lower 
     healthcare costs, but the framework before the House today 
     would pave the way for policies that do just the opposite, 
     putting affordable access to healthcare out of reach of 
     millions of Americans.

  Feeding America--I love this organization:

       Cuts to vital federal nutrition programs like SNAP, 
     necessitated by this resolution and the Senate version passed 
     last week, will harm families grappling with high food costs, 
     hurt rural economies and strain food banks already 
     overwhelmed by rising demand. We urge the House to reject 
     spending cuts to nutrition programs in the budget 
     reconciliation process and support the work the House and 
     Senate agriculture committees are doing to create a strong, 
     bipartisan farm bill.

  The Federal AIDS Policy Partnership:

       We are writing on behalf of 95 national, regional, and 
     local organizations advocating for Federal funding 
     legislation and policy to end the HIV epidemic in the United 
     States. We urge Congress to reject all proposals to enact 
     cuts to Medicaid, whether through per-capita caps or block 
     grants, restrictions to the Federal Medical Assistance 
     Percentage, or FMAP, or mandatory work requirements during 
     reconciliation for the 2025-2026 fiscal year budgets.
       Medicaid is the most important source of health coverage 
     and lifesaving care for people living with HIV--

  The most important source of health coverage and lifesaving care for 
people living with HIV--

     providing coverage for more than 40 percent of the people 
     living with HIV and contributing 45 percent of all Federal 
     funding for domestic HIV care and treatment.

  The next letter starts:

       To be clear, the cuts outlined above are being proposed for 
     one simple reason: to pay for $4.5 trillion in tax breaks 
     that disproportionately benefit the wealthy. Congress can and 
     must take a different path--

  Congress must take a different path--

     one that lifts more families out of poverty and provides more 
     Americans with the opportunity to reach their full potential. 
     A people-first agenda should include expanding the child tax 
     credit for the 17 million children who don't receive the full 
     credit due to low family incomes, expanding rental 
     assistance, increasing SNAP benefits to reflect rising 
     grocery prices and closing the Medicaid coverage gap.

  If Congress focused on ensuring that wealthy Americans pay their fair 
share rather than providing additional tax breaks, we could fund these 
initiatives and so much more.
  This is a group of groups that you will recognize or many people will 
recognize: American Association of Nurse Practitioners, Gerontological 
Advanced Practice Nurses Association, the National Association of Nurse 
Practitioners in Women's Health, National Association of Pediatric 
Nurse Practitioners, and the National Organization of Nurse 
Practitioner Faculties. They write:

       We are deeply concerned with the impact of these cuts on 
     the healthcare system and their potential to harm our most 
     vulnerable patients. Further, these cuts will threaten the 
     viability of practices that treat Medicaid patients, 
     financially destabilizing and having a disproportionate 
     impact on those who provide care to underserved and rural 
     communities.

  Association of American Medical Colleges, AAMC:

       We remain extremely concerned that the budget resolution's 
     reconciliation instructions would result in unsustainable 
     cuts to Federal healthcare programs--specifically Medicaid--
     by requiring at least $880 billion in savings from the House 
     Energy and Commerce Committee. Cuts of this magnitude would 
     jeopardize both access to care for millions of Medicaid 
     enrollees and the financial stability of the providers who 
     care for them.

  Here is one from Chimes International:

       Cuts in Medicaid will have a dramatic negative impact on 
     our healthcare system and the first responder community. 
     Millions of Americans will be at risk of losing access to 
     housing, thereby increasing homelessness for some of the most 
     vulnerable members of society, especially in areas that 
     already lack affordable housing. Provider organizations like 
     ours will be forced to close the doors of residential 
     facilities and reduce support staff, which is already in 
     short supply.

  Katie Smith Sloan, who is the president and CEO of LeadingAge:

       States would have to fill in massive budget holes if 
     Federal funding to Medicaid programs were cut. Even if a cut 
     such as a change to the expansion FMAP proposal does not seem 
     to directly impact aging services, it would because the cost 
     of the cut would have to somehow be absorbed by State 
     budgets. That type of hole cannot be filled in via

[[Page S1946]]

     more efficiency. Balancing the 10-year program budget cycle 
     on the back of the Medicaid program is not a good tradeoff 
     for the American people.

  Alan Morgan, who is the CEO of the National Rural Health 
Association--this letter is powerful. He represents the National Rural 
Health Association:

       Any cuts to the Medicaid program will disproportionately 
     affect rural communities. Rural Americans rely on Medicaid 
     coverage, with about 20 percent of non-elderly adults and 40 
     percent of children living in rural areas enrolled in 
     Medicaid and CHIP. In almost all States, rural areas have 
     higher rates of Medicaid enrollment than metropolitan areas. 
     Cuts to Medicaid would shift healthcare costs onto rural 
     families, many of whom already struggle with financial 
     instability. Medicaid cuts would force families to face 
     higher out-of-pocket expenses, leading many to delay or forgo 
     necessary treatments. The burden would worsen health 
     outcomes, especially for those managing chronic conditions 
     like diabetes, heart disease, and cancer.

  To the extraordinary prescience of my colleague from Delaware, who 
knew this letter was coming, I imagine, this is a letter from the U.S. 
Conference of Mayors, the National League of Cities, the National 
Association of Counties, the National Conference of State Legislatures, 
the Council of State Governments, and the International City/County 
Management Association.
  I am going to pause for a second just to remind folks--because I have 
been involved in the U.S. Conference of Mayors and the National League 
of Cities. I have dealt with the National Association of Counties on 
things that were important here in the Senate. All of these groups are 
bipartisan. All of these groups represent Democrat and Republican 
mayors, Democrat and Republican city council people.
  I was actually a nonpartisan mayor. New York does not have partisan 
elections. So they have nonpartisan folks.
  This is a group of people who have those jobs where the rubber meets 
the road. A change in State policy, a change in Federal policy--we had 
to eat it when I was mayor if it cost us more money. I was a mayor that 
talked like lots of mayors do, not in partisan lingo. They just talk 
about: Hey, it is an unfunded mandate. Hey, that is adding more 
bureaucracy. Hey, that is going to cause more people in my community to 
be homeless. It is going to cause more children in my community to use 
an emergency room as their primary care physician.
  When I meet a mayor, I look at them and I thank them because it is 
one of the hardest jobs in America.
  So this organization that represents Democrats and Republicans--they 
write:

       As a coalition of bipartisan membership organizations 
     representing State legislatures, mayors, cities, and 
     counties, we are committed to working collaboratively to 
     strengthen the Medicaid program so that the States and 
     localities can continue to meet the needs of their residents 
     effectively. We write to express concern over proposed 
     changes to Medicaid financing and requirements that could 
     significantly impact State and local budgets, healthcare 
     infrastructure, and millions and millions of Americans who 
     rely on the program.

  I would say so far there are at least half a dozen to a dozen of 
these letters where bipartisan groups are saying: Let us help you. 
Don't rush this through in a way that is going to cause havoc to State 
and local governments, cause havoc to children and seniors and the 
disabled, cause havoc to hospitals and businesses, cause havoc to rural 
communities, cause havoc to the idea of what it means to be an 
American: that we take care of our own, that we stand up for each 
other, that we lend a hand, that we lift folks up. And here it is, this 
voice of bipartisan sensibility that says: Hey, hold a hearing. We will 
come. Put some of us on a commission.
  This is a group called Advocates for Community Health:

       Medicaid's successes as a national program derive from its 
     variations across different States.

  Different States doing things in different ways.

       Medicaid looks different in every State and territory 
     because the program is able to reflect and accommodate the 
     specific needs of the State's patients, providers, and 
     communities.
       These State-based programs are vital to the patients served 
     by community health centers, patient-to-direct primary care 
     providers that serve rural and underserved communities 
     nationwide.
       As the House and Senate work toward a budget reconciliation 
     package, Advocates for Community Health encourages a cautious 
     approach to changes to Medicaid policy as broad changes have 
     a potential to destabilize State Medicaid programs and 
     community health centers, impact local economies and job 
     creation, and further exacerbate rural healthcare access 
     challenges.

  Families USA. Their executive director--his name is Anthony Wright:

       Americans are storming townhalls, calling their 
     Representatives in Congress, and demanding that House 
     Republicans stop their plan to massively cut the healthcare 
     that Americans want and need. President Trump and some 
     Republicans have said they won't touch Medicaid, but their 
     vote today is when we see who walks the walk. The vote is the 
     walk-the-plank moment for moderates who say they don't want 
     Medicaid cuts but are being asked to cut over $880 billion to 
     the care and coverage of their constituents.
       Policymakers and the public alike understand that there is 
     no version of this budget resolution that does not include 
     deep cuts to vital programs, services, and benefits the 
     American people use every day to help them see a doctor, pay 
     rent, or feed their families.

  Justice in Aging is an organization that is led by its executive 
director, Kevin Prindiville. He writes:

       With this vote, lawmakers endorsed taking away Medicaid 
     from millions of Americans, including older adults, all to 
     bankroll tax cuts for the wealthy. Thanks to our collective 
     advocacy, the vote to pass this dangerous budget blueprint 
     did not come easily, and we will make sure lawmakers know 
     that voting to enact these cuts would be voting to abandon 
     older Americans.

  The National Alliance for Caregiving:

       The House budget blueprint to eliminate at least $800 
     billion in Federal funding unfairly targets critical 
     healthcare and supportive services that older adults, people 
     with diabetes, and their family caregivers depend upon to 
     maintain health and economic security for families and 
     themselves.
       Home- and community-based services funded via Medicaid are 
     cost-effective. They save millions of taxpayer dollars on 
     unnecessary and often unwanted institutional care. Most of 
     all, Medicaid-funded HCBS--

  Home- and community-based services--

     offers consumers a choice in how they receive care in the 
     dignity of their own homes.

  In the dignity of their own homes. Dignity.
  The Coalition for Whole Health Legal Action Center:

       Among the options being discussed are work requirements for 
     enrollees, despite the fact that most people receiving 
     Medicaid do work, and other cuts to Federal funding that 
     would disproportionately harm people with substance abuse and 
     mental health conditions and those with arrest and conviction 
     records by making it harder to access critical health 
     coverage and service, medications, and support.
       Such individuals already face pervasive stigma and 
     discrimination, including significant barriers to employment 
     that threaten their stability and well-being, at a time when 
     overdose and suicide are claiming more than 400 lives a day. 
     We cannot afford to reduce access to comprehensive healthcare 
     services that people with substance abuse use, mental health 
     conditions, and those rebuilding their lives after 
     incarceration desperately need to recover and thrive.

  Let me tell you something about that that really strikes me. I was 
blessed to go to colleges, and there, people would use drugs. Now I 
live in a community where the consequences for drug use often mean jail 
time. In fact, if you look at low-income people, their chances of being 
incarcerated are far greater than college kids, who have drug usage 
rates at about the same.
  So now you say to somebody who has an arrest record and served some 
time that when they come out, they can't get help? People with mental 
illness are over-incarcerated. You are going to say to them ``You have 
this mental illness. Now you have a record, and you also can't get 
healthcare services?'' That is, again, self-defeatist when it comes to 
our Nation trying to give people ways of elevating themselves above 
their past mistakes or the diseases that challenge them.
  Here is another group, Community Catalyst:

       These cuts will hit hardest where healthcare access is 
     already fragile.

  Here is the Alliance for Ageing Research:

       We, the undersigned organizations, urge you to oppose any 
     cuts to Medicaid and the Supplemental Nutrition Assistance 
     Program, SNAP, including those called for in the proposed 
     budget resolution. We are concerned about the negative impact 
     these deep cuts will have on the Americans living with 
     chronic disease and other disabilities.
       But we are willing to draw your attention now to how 
     devastating it will be on those with Alzheimer's and related 
     diseases, including frontotemporal degeneration and Lewy body 
     dementia, and their family caregivers.

  April Verrett, the president of SEIU:


[[Page S1947]]


  

       Let's be clear, Americans have flooded congressional phone 
     lines, rallied at townhalls, and lifted their voices to make 
     it clear that they do not want massive cuts to the healthcare 
     and public services they depend on. Despite that, today 
     Speaker Johnson pressed a budget resolution forward that puts 
     our Nation on a disastrous path to ripping away healthcare 
     from 80 million children, pregnant women, veterans, seniors, 
     people with disabilities by gutting Medicaid.

  Lee Saunders, the president of AFSCME:

       This budget proves that extremists are more concerned with 
     giving wealthy trillions in tax cuts than helping working 
     people. Voters across the country are packing townhalls to 
     demand no cuts to Medicaid and SNAP. They are calling 
     Representatives and asking them, Please save these services.
       They want elected leaders who will lower rising costs, who 
     make it easier to afford rent and food, but instead of 
     listening to workers, the House moved forward on a budget 
     plan that will cause millions to lose their healthcare, 
     increasing food insecurity for families, and jeopardize 
     Medicare and Social Security in the long term.

  He calls this ``shameful.''
  The Diabetes Leadership Council and the Diabetes Patient Advocacy 
Coalition:

       We are deeply concerned about the budget resolution passed 
     in the House of Representatives this week. This budget 
     resolution will likely lead to cuts to the safety-net 
     Medicaid programs, which provide health insurance to almost 
     80 million Americans, including children, pregnant women, 
     elderly adults, people with diabetes, and low-income adults 
     and families.
       This action would disproportionately impact Americans who 
     most need us, including those with diabetes or other chronic 
     conditions who rely on Medicaid to access medications and 
     technology that they need to manage their conditions.
       Members of Congress should, instead, work to ensure access 
     to health insurance through the Medicare program--work to 
     ensure access to healthcare without barriers for the most 
     vulnerable Americans.

  Here is the Alliance for Childhood Cancer:

       Work requirements may also impact caregivers of children 
     with cancer who are unable to work due to the demands of 
     cancer treatment for young adults with cancer who may not be 
     eligible for insurance via their employer or may not be able 
     to work due to their diagnosis. Many young adults rely on 
     Medicaid, especially Medicaid expansion, for coverage, and 
     research shows a clear increase in survival for young adults 
     with cancer in Medicaid expansion States.

  UnidosUS:

       The proposed resolution would slash at least $880 billion 
     from programs that have long provided lifesaving, affordable 
     coverage to millions of Americans. Medicaid alone serves 80 
     million people, covering nearly 40 million children, half of 
     those with special healthcare needs, and more than 40 percent 
     of all births.
       In Latino communities, Medicaid reaches 20 million 
     individuals, protecting nearly one-third of community 
     members, more than half of Latino children, and roughly 30 
     percent of Hispanic elders. Without these vital programs, it 
     would be higher hospitalization rates, delayed diagnoses, and 
     increased mortality. This would become the norm, placing an 
     unsustainable strain on public health and national financial 
     security.

  As UnidosUS recently pointed out, these proposed cuts would represent 
the largest cuts to Medicaid in U.S. history.
  The Coalition of Survivors of Domestic Violence and Sexual Assault:

       On behalf of the adult and child survivors of domestic 
     violence and sexual assault, we serve and advocate for them. 
     We, on behalf of them, write to ask you to reject cuts to 
     Federal Medicaid funding.
       Survivors rely on Medicaid every day to escape abuse, to 
     rebuild their lives after violence, to care for their 
     children and families.

  The Catholic Health Association of United States, the United States 
Conference of Catholic Bishops, and Catholic Charities USA:

       Weakening Medicaid through structural challenges such as 
     per capita caps or block grants would undermine these values 
     and risk leaving millions without access to essential health 
     services.
       Furthermore, policies like work reporting requirements have 
     shown clear evidence of creating artificial barriers to care, 
     generating paperwork and bureaucracy while doing little to 
     support people looking for work. These requirements also fail 
     to recognize that most people on Medicaid already work and 
     ignore the realities of low-wage workers, caregiving 
     responsibilities, and health limitations, and studies have 
     shown they frequently result in loss of coverage for eligible 
     individuals and children.

  The Disability and Aging Collaborative and the Consortium for 
Constituents with Disabilities on behalf of 107 national organizations 
and more than 230 State and local organizations:

       The undersigned members of the Disability and Aging 
     Collaborative, the health and long-term service and support 
     task forces of the Consortium for Constituents with 
     Disabilities, and allied organizations write to urge you to 
     exclude Medicaid cuts, work requirements, or any changes that 
     limit funding or eligibility from budget reconciliation or 
     other legislation.
       People with disabilities, older adults, family caregivers 
     and their children, direct care workers and other low-income 
     individuals and families depend on Medicaid every day for 
     their health, safety, and independence. Medicaid enables our 
     communities to go to work and to care for loved ones. It is 
     our community's lifeline, and we cannot afford for any part 
     of it to be cut.

  (Mr. BANKS assumed the Chair.)
  The Jesuit Conference:

       Programs that meet basic needs such as SNAP, Medicare and 
     Medicaid, health insurance premium tax credits, and Social 
     Security should be protected and remain as robust as 
     possible. We oppose modifications that would have the effect 
     of reducing important benefits or excluding vulnerable people 
     from participating.

  Thank you, the Jesuit Conference.
  Why? I mean, we have just read dozens and dozens of letters from real 
people who are relying on these programs to take care of their elderly 
parents, to take care of their loved one with dementia, to take care of 
their children, to take care of their adult children with disabilities, 
to take care of their children with special needs, to take care of 
their families, to take care of their communities, to take care of 
rural towns, to take care of the hospitals that take care of people.
  Why? Why? Why are all of these people lifting their voices now, 
pointing to the crisis that can't be normalized, pointing to the 
challenges? Because we have seen this reconciliation process call for 
$880 billion of cuts, when, as I read earlier, there is only one place 
that the majority of those cuts can come from, and that would be 
hundreds of millions of dollars in cuts to Medicaid, which organization 
after organization told you it is already a delicate balance; that cuts 
to these programs could ultimately tear down people's access to 
lifesaving benefits.
  People use the word ``dignity'' over and over again--dignity. It is a 
value in our country that we treat our elders with dignity, that we 
give people struggling with chronic disease dignity, that we give 
parents who are slammed with the unimaginable diagnoses for their 
children--we help them to access dignity.
  People that we have talked about and that we read their letters, they 
all said: We can help you find efficiencies. We can help you make the 
programs work better. We can help you, but why are you doing this if it 
is all part of a larger package to give tax cuts to the wealthiest 
Americans, to give tax cuts to billionaires? How does that work?
  That Elon Musk should get richer and richer and richer, and 
families--the love in these letters--who love their children, who love 
their aging parent, who love that person with dementia, even though 
they don't recognize them anymore. But that doesn't stop the heroic 
love. And they piece together their finances in a nation where housing 
costs are going up, food costs are going up, and transportation is 
going up. They piece together the fragile finances of their lives. The 
Medicaid funding is one part of it that gets yanked away, and 
everything unravels. Why, they ask, why? They plead for help. They ask 
us to do something.
  I want to read some articles, coming from a variety of backgrounds--
but perhaps this one from PBS, ``A closer look at who relies on 
Medicaid.''
  This is what PBS wrote:

       As congressional Republicans seek about $4.5 trillion to 
     extend expiring tax cuts, the Federal Government will need to 
     find savings elsewhere.

  You are going to give that $4.5 trillion that disproportionately go 
to the wealthy, and you are going to have to find savings elsewhere.

       Experts say budget cuts could affect Medicaid coverage for 
     as many as millions of Americans, at a time when the program 
     may need more funding, not less.
       The proposed House bill requires the Committee on Energy 
     and Commerce to find $880 billion in spending cuts, which 
     means some aspects of Medicaid, which the committee oversees, 
     may be on the chopping block.
       Medicaid is a massive . . . program that provides free and 
     reduced-cost health care for eligible enrollees. It offers 
     critical coverage to a wide variety of Americans, including 
     children, adults with disabilities and older people in 
     nursing homes.
       Even for Americans who have private insurance, Medicaid can 
     play a part in their health care. That's because Medicaid is 
     such a large engine of funding for so many aspects of the 
     country's health coverage.


[[Page S1948]]


  So many benefit from these aspects of this country's health coverage.

       The public health insurance option is funded in part by the 
     Federal Government and in part by states, covering around 72 
     million [Americans].
       The Federal Government spent about $880 billion on Medicaid 
     in fiscal year 2023, the most recent year for which there's 
     data, according to an analysis by the nonprofit health policy 
     research organization KFF.
       Medicaid is an extremely popular entitlement program, said 
     Robin Rudowitz, director of the program on Medicaid and the 
     uninsured at KFF.
       More than 9 in 10 adults say Medicaid is ``very'' or 
     ``somewhat'' important to their local community, according to 
     recent KFF polling. Forty percent of respondents said they 
     wanted Medicaid funding to remain the same, while 42 percent 
     wanted to increase funding for the program. Just 17 percent 
     wanted to decrease funding ``a little'' or ``a lot.''
       Some studies have found that expanding Medicaid can save 
     money for states, including in spending reductions in 
     corrections health care as well as mental health and 
     substance abuse care.

  Pulling away from the article for a second, that is so logical. 
Expanding health coverage for people with mental health challenges or 
substance abuse means an investment now and saves a lot of money for 
society later and saves them from being rearrested because of their 
disease.
  Back to the article:

       President Donald Trump has said his administration will not 
     cut Medicaid benefits, and will instead reduce spending by 
     eliminating waste and fraud.
       [Well,] according to health policy experts, there may not 
     be a way to fund the tax cuts without cutting Medicaid. Doing 
     that will have real implications, said Allison Orris, senior 
     fellow and director of Medicaid policy at the Center on 
     Budget and Policy Priorities.

  Another nonpartisan group.

       ``It's fair to say if Medicaid is cut by hundreds of 
     billions of dollars, people will lose coverage. But some of 
     the ways in which they will lose coverage and health care and 
     access are a little bit tricky,'' she said.
       [So] who and what relies on Medicaid?
       Medicaid covers low-income Americans in all 50 states, as 
     well as D.C. and the American territories, but the program's 
     benefits are farther reaching.
       Medicaid pays for around 2 in every 5 births in the 
     country. The program accounts for about 20 percent of both 
     hospital funding and total health care spending nationwide, 
     according to KFF. That organization's analyses of hundreds of 
     studies conducted since 2014 largely found that Medicaid 
     expansion helped cut hospital costs associated with uninsured 
     patients. Many studies also found that Medicaid expansion 
     helped with overall hospital funding and resulted in fewer 
     hospital closures.
       And Medicaid--not Medicare--is the single largest payer of 
     long-term coverage, including nursing home care.
       Here are some of the ways Medicaid is crucial for so many 
     Americans' health care.
       Long-term care for people with disabilities.
       According to KFF analyses, 35 percent of Americans with 
     disabilities have Medicaid, [that is about] 15 million 
     people. That compares with 19 percent of people without 
     disabilities, [and] the majority of whom have employer-
     provided health insurance.
       Currently, Medicaid covers about 60 percent of long-term 
     care coverage, much of which provides care for younger adults 
     with disabilities.
       Nursing homes.
       Medicaid is the primary payer of nursing care in the U.S.; 
     it covers 63 percent of nursing home residents.
       For many older adults, ``Medicaid is the safety net,'' says 
     David Grabowski, professor of health care policy at Harvard 
     Medical School. ``An individual can be middle-income their 
     entire life and then reach their older, long-term care years 
     and have to enter a nursing home.''
       Because nursing homes can be so expensive, families can 
     quickly deplete [all of] their assets, then rely on Medicaid 
     to cover long-term care.

  Another group:

       Children.
       Thirty-seven percent of people enrolled in Medicaid are 
     children, but they account for only about 15 percent of the 
     program's spending.
       In 2023, KFF found that of the 72 million people enrolled 
     in Medicaid, about 30 million were children. Millions more 
     children are enrolled in the Children's Health Insurance 
     Program, which some states run with Medicaid expansion funds.

  They are tied. Forgive me. That is off the article.
  Back to the article:

       So far, political conversation has not yet focused on 
     cutting CHIP.
       Rural maternal health.
       Medicaid covered around 40 percent of births nationwide in 
     2023, KFF found, and nearly half--

  Nearly 50 percent--

     of all rural births.
       Studies also show that being enrolled in Medicaid leads to 
     improved health outcomes for children, including declines in 
     infant and child mortality, preventive care visits on par 
     with privately insured children and even potentially positive 
     outcomes into adulthood, such as improvements in education.

  That is what studies show being enrolled in Medicaid leads to.
  How about Native Americans and Alaskan Indians?

       Four in 10 American Indian/Alaskan Native people are 
     enrolled in Medicaid, the highest enrollment rate among any 
     race and ethnicity category. This includes about 23 percent 
     of nonelderly AIAN adults and 44 percent of [American Indian/
     Alaskan Native] children.
       How the Federal Government funds the states' Medicaid 
     plans.
       Medicaid began as an optional program in 1966 alongside 
     Medicare, with around 8 million people eligible for 
     enrollment. By the 1980s, all states had opted into providing 
     health insurance through Medicaid.
       Though eligibility requirements have changed over the last 
     60 years and vary by state, the most significant change to 
     Medicaid was the enactment of the Patient Protection and 
     Affordable Care Act in 2010. It required states to cover 
     adults with incomes up to 138 percent of the [federal] 
     poverty line. After the Supreme Court ruled in 2012 that 
     expansion for states should be optional, 40 states and 
     Washington, D.C., have expanded Medicaid.

  Forty of our 50 States accepted ``federal funds at a much higher rate 
than the match rate for non-expansion coverage.''
  That is a good summary by PBS of how far-reaching this program is, 
how many Americans in every single State, from all backgrounds, from 
both sides of the political aisle--Independents, old, young, hospitals, 
businesses, care professionals, and more--this is who we are. We have 
expanded the program. We have made it better. We have brought 
improvements. And yet we are doing a process, and it is not going 
through a committee. We are not soliciting the best ideas from both 
sides of the aisle about how to make it more efficient, more effective. 
We are not bringing in private sector professionals to give advice and 
input or hospital providers or people that are seeing things that we 
can learn from and craft legislation to make the program better.
  And the letters are even showing that we are not even doing any of 
those things, and then we are cutting the very programs that allow 
people access to fresh, healthy food, that then cause us to need more 
health care for chronic diseases.
  This alone would be bad enough if we were gutting a program with no 
input from professionals, if we were taking away healthcare from 
seniors, children, expectant mothers, the disabled. That would be bad 
enough.
  But why? Again, why? Because it is part of a larger budget package to 
give trillions of dollars in tax cuts disproportionately to the 
wealthiest Americans and still add trillions to the national deficit.
  I talked about American Indians and Alaskan Natives. I mentioned that 
I recently visited some proud Native Americans and heard their stories 
and was inspired by their conviction and their grit, and how under 
incredible odds, they were able to create better lives. After 
extraordinary oppression and vicious policies and more, they found a 
way forward.
  There is a disproportionate number of Native Americans and Alaska 
Natives that rely on these programs, people who have maintained 
extraordinary dignity despite promises made and promises broken.
  So many people are talking about that idea of a sacred trust; that 
the richest Nation in the world, to honor its ideals of freedom, has to 
focus on keeping people free from fear that one medical bill will throw 
their family in crisis or fear that one diagnosis for their child will 
unravel their lives or fear that, if their parent gets dementia, there 
will be no care for them.
  So much of this conversation is within this larger understanding of 
who we are, and what do we stand for. I want to take a look at some of 
the things the Trump administration is doing that is going to undermine 
not just Medicaid but health insurance coverage for Americans, for all 
Americans, and raise the cost of healthcare, and negatively impact our 
health. At a time when basic prices of everyday goods are going up, the 
President is making healthcare harder to access and drug prices even 
higher.
  I want to explain this. On his first day back in office, Trump 
rescinded the

[[Page S1949]]

policy that extended the enrollment period for ACA plans. This policy 
gave Americans sufficient time to enroll in healthcare for the year, 
and enrollment in the ACA continues to go up as people see how 
affordable this program is and how they can get quality healthcare. But 
the first thing--one of the first things he does--is rescind the policy 
that extended the enrollment period.
  In addition to this, Republicans in Congress want to take away the 
tax credits that make healthcare more affordable for so many people. 
Millions of working-class Americans rely on Affordable Care Act tax 
credits to access affordable, quality healthcare and coverage.
  I could go on with the things. For example, currently these tax 
credits, they are set to expire at the end of this year. If these tax 
credits were taken away, families will pay up to 90 percent more for 
their healthcare, and 5 million Americans could lose their healthcare 
altogether. All, again, if this goes through in 2025, billionaires and 
CEOs will get a huge tax break while working Americans relying on this 
tax credit will lose it.
  Think about that. This would allow billionaires and CEOs to get more 
of a tax break, while these tax credits that help more Americans access 
healthcare would expire.
  For New Jerseyans, ending the ACA tax credit would make health 
insurance less affordable for 352,000 hard-working people and their 
families and would force 75,000 people to go uninsured--75,000 people 
in my State alone.
  Last year, 24 million people chose Affordable Care Act plans during 
the most recent open enrollment due to these expanded tax credits that 
made plans available to people for little or no monthly premiums and 
extended the enrollment period, which I just said the President has 
rolled back.
  President Trump also overturned an effort for Medicare to lower drug 
costs like implementing a $2 monthly out-of-pocket cap on certain 
generic drugs as well as a measure that would reduce Medicare payments 
for rare disease drugs and drugs that treat life-threatening 
conditions.
  I just don't understand that. I really see that as cruel. Americans 
struggling to afford their drugs had a cap of out-of-pocket expenses on 
certain generic drugs, and that was overturned.
  Costs are going up. Costs are going up. And now this President is 
expanding costs for out-of-pocket generic drugs as well as Medicaid 
payments being eligible for rare diseases.
  I had the privilege of becoming close to John McCain. I came here in 
the Senate, got this admonition, almost, from Bill Bradley, somebody 
who held my seat beforehand, and he challenged me to go and have lunch 
with or meetings with all my Republican colleagues at the time. That 
was way back in 2013. And I was told by John McCain's staff that I had 
like 10, 15 minutes, but I was going to take it. This is John McCain. 
He is legend.
  And I go in and meet with him, and I don't come out of that office 
for 90 minutes. We both got emotional as he showed me pictures and 
documentation from his time as a prisoner of war.
  In 2017, he was under extraordinary pressure in this healthcare 
crisis, and there were thousands of Americans descending on our 
Capitol. I will never forget the ``little lobbyists,'' they called 
themselves, kids in wheelchairs that would roll up to Congress people 
and raise their little voice, respectfully, and ask them not to take 
away their health coverage.
  I remember people coming in here with preexisting conditions and 
saying: Don't repeal my healthcare and not even have a plan to replace 
it.
  President Trump was asked about healthcare when he was Candidate 
Trump for this office, and he said he had, I think it was, 
``conceptions of a plan.'' And since he has been in office, I haven't 
heard a vision for healthcare besides budget proposals that would cut 
people's healthcare.
  But John McCain, I will never ever forget that moment. I was actually 
standing on the Republican side, if I remember correctly, having 
conversations, and he came to the floor, after listening to Arizonans 
tell stories like the ones I have been reading, and put his thumb down.
  He wrote a speech about his decision, and I want to read a part of 
that now.

       I have been a Member of the U.S. Senate for 30 years. I had 
     another long, if not as long, career before I arrived here, 
     another profession that was profoundly rewarding and in which 
     I had experiences and friendships that I revere. Make no 
     mistake, my service here is the most important job I have had 
     in my life. I am so grateful to the people of Arizona for the 
     privilege--for the honor--of serving here and the 
     opportunities it gives me to play a small role in the history 
     of the country I love.
       I have known and admired men and women in the Senate who 
     played much more than a small role in our history--true 
     statesmen, giants of American politics. They came from both 
     parties and from various backgrounds. Their ambitions were 
     frequently in conflict. They held different views on the 
     issues of the day. They often had very serious disagreements 
     about how best to serve the national interest.
       But they knew that however sharp and heartfelt their 
     disputes and however keen their ambitions, they had an 
     obligation to work collaboratively to ensure the Senate 
     discharged its constitutional responsibilities effectively. 
     Our responsibilities are important--vitally important--to the 
     continued success of our Republic. Our arcane rules and 
     customs are deliberatively intended to require broad 
     cooperation to function well at all. The most revered Members 
     of this institution accepted the necessity of compromise in 
     order to make incremental progress on solving America's 
     problems and to defend her from her adversaries.
       That principled mindset and the service of our predecessors 
     who possessed it come to mind when I hear the Senate 
     referred to as the world's greatest deliberative body. I 
     am not sure we can claim that distinction with a straight 
     face today. I am sure it wasn't always deserved in 
     previous eras either. I am sure there have been times when 
     it was, and I was privileged to witness some of those 
     occasions.
       Our deliberations today, not just our debates but the 
     exercise of all our responsibilities--authorizing government 
     policies, appropriating the funds to implement them, 
     exercising our advice and consent role--are often lively and 
     interesting. They can be sincere and principled, but they are 
     more partisan, more tribal more of the time than at any time 
     I can remember. Our deliberations can still be important and 
     useful, but I think we would all agree they haven't been 
     overburdened by greatness lately. Right now, they aren't 
     producing much for the American people.
       Both sides have let this happen. Let's leave the history of 
     who shot first to the historians. I suspect they will find we 
     all conspired in our decline, either by deliberate actions or 
     neglect. We have all played some role in it. Certainly, I 
     have. Sometimes, I have let my passion rule my reason. 
     Sometimes I made it harder to find common ground because of 
     something harsh I said to a colleague. Sometimes I wanted to 
     win more for the sake of winning than to achieve a contested 
     policy.
       Incremental progress, compromises that each side criticizes 
     but also accepts, and just plain muddling through to chip 
     away at problems and to keep our enemies from doing their 
     worst aren't glamorous or exciting. It doesn't feel like a 
     political triumph. It is usually the most we can expect from 
     our system of government, operating in a country as diverse, 
     quarrelsome, and free as ours.
       Considering the injustice and cruelties inflicted by 
     autocratic governments and how corruptible human nature can 
     be, the problem-solving our system does make possible, the 
     fitful progress it produces, and the liberty and justice it 
     preserves, are a magnificent achievement.
       Our system doesn't depend on our nobility. It accounts for 
     our imperfections and gives an order to our individual 
     strivings that has helped make ours the most powerful and 
     prosperous society on Earth. It is our responsibility to 
     preserve that, even when it requires us to do something less 
     satisfying than winning, even when we must give a little to 
     get a little, even when our efforts managed just 3 yards in a 
     cloud of dust, while critics on both sides denounced us for 
     timidity, for our failure to triumph.
       I hope we can again rely on humility, on our need to 
     cooperate, on our dependence on each other to learn how to 
     trust each other again and, by so doing, better serve the 
     people who elected us. Stop listening to the bombastic 
     loudmouths on the radio and television and the internet. To 
     hell with them. They don't want anything done for the public 
     good. Our incapacity is their livelihood.
       Let's trust each other. Let's return to regular order. We 
     have been spinning our wheels on too many important issues 
     because we keep trying to find a way to win without help from 
     across the aisle. That is an approach that has been employed 
     by both sides: mandating legislation from the top down, 
     without any support from the other side, with all the 
     parliamentary maneuvers it requires. We are getting nothing 
     done.
       All we have really done this year is confirm Neil Gorsuch 
     to the Supreme Court. Our healthcare insurance system is a 
     mess. We all know it, those who support Obamacare and those 
     who oppose it. Something has to be done. We Republicans have 
     looked for a way to end it and replace it with something else 
     without paying a terrible political price. We haven't found 
     it yet. I am not sure we will. All we have managed to do is 
     make more popular a policy that wasn't very popular when we 
     started trying to get rid of it.

[[Page S1950]]

     I voted for the motion to proceed to allow debate to continue 
     and amendments to be offered.
       I will not vote for the bill as it is today. It is a shell 
     of a bill right now. We all know that. I have changes urged 
     by my State's Governor that will have to be included to earn 
     my support for final passage of any bill. I know many of you 
     will have to see the bill changed substantially for you to 
     support it. We have tried to do this by coming up with a 
     proposal behind closed doors in consultation with the 
     administration, then springing it on skeptical Members, 
     trying to convince them it is better than nothing--that it is 
     better than nothing--asking us to swallow our doubts and 
     force it past a unified opposition. I don't think that is 
     going to work in the end and probably shouldn't.

  That is prescient. I mean, that is prescient. As a great New 
Jerseyan, Yogi Berra says ``It's like deja vu all over again.'' To hear 
what John McCain was criticizing--one party behind closed doors without 
consultation of experts, against the wishes of Republican Governors, is 
trying to force something through past a united opposition--he 
literally is describing what is happening right now and condemning both 
sides of this institution for playing this record over and over and 
over again.
  Yes, I am a Democrat, and I admit that our healthcare system needs so 
much help and so much reform. One out of every three of our tax dollars 
is being spent on healthcare. That is ridiculous. And what are we 
getting from it? A society that is getting more and more sick.
  And what are our solutions as a body? Did we come together as a team? 
Did we set up a special conference, set up a special committee to study 
the issues, to bring in the experts, to involve the best technology, to 
learn the lessons from private sector and public sector, from 
universities, from scientists--are we doing that, or are we doing 
exactly what John McCain said we shouldn't do, exactly what he 
described why he voted no?
  It is maddening in this country to create greater and greater 
healthcare crises and for us not to solve it but to battle back and 
forth between trying to make incremental changes or to tear it all down 
with no plan to make it better, leaving more and more Americans 
suffering what is still one of the most significant ways people go 
bankrupt, which is not being able to afford their healthcare.
  And what are we doing it for this time, John? Senator McCain? I know 
you wouldn't sanction this. I know you would be screaming. I have seen 
how angry you can get, John McCain. I have seen you tear people apart 
on the floor, Democrat and Republican, for doing the same stupid thing 
over and over again.
  Listen to John McCain explain why he voted no the last time the 
Republican Party tried to unite and tear down healthcare with no idea 
how to fix it and threatening to put millions of Americans in financial 
crisis and healthcare crisis.
  I can't believe we are here again with thousands upon thousands upon 
thousands of Americans writing letters, storming into townhalls--
hospital leaders, private sector leaders, Republican Governors, 
Republican mayors, Democrat Governors, Democrat mayors, all saying: 
What are you doing in Congress and why?
  I think what is even more outrageous this time is the why--to redo 
the tax cuts that independent budget analysis says, no, that the 
overwhelming benefit went to the billionaires who sat on stage with 
Donald Trump during his inauguration. We are not saving any money in 
our budgets. Their plan is to expand our budget crisis. Their plan will 
add trillions of dollars to our budget and give tax cuts to the 
wealthiest and not help the people that John McCain is talking about. 
His echoes haunt me that he said we are mistaken when we don't come 
together across the aisle--across our differences--to try to make 
things better.
  There is a healthcare crisis in this country. One out of three 
dollars in our government is going to healthcare. And we have more 
chronic disease in this Nation than we have ever had before. And there 
is no solution being offered in this reconciliation to deal with that. 
In fact, we are making it worse because we are denying children access 
to healthy foods. This is ridiculous.
  If they are successful, what kind of country will we be with more 
stratifications of wealth, with people who have done so good?
  I am not one of these Democrats who hates successful or wealthy 
people. Heck, people in my neighborhood--I am the only Senator that 
probably lives in a low-income neighborhood--strive to be wealthy. They 
are doing great. The top quartile of our country the last 20 years has 
made extraordinary wealth. God bless them.
  But when you see that 70, 80 percent of Americans don't want Medicaid 
cuts because most Americans know neighbors, family members, church 
members who rely on Medicaid; they know that their grandmother in a 
nursing home relies on Medicaid; they know that the disabled child next 
door relies on Medicaid. And now we want to gut it $880 billion?
  John McCain--most people remember the thumb down. They don't remember 
his words; they don't remember the warnings. This man is in Heaven now 
and his words, they speak to us in this moment again. Why won't we 
listen to them?

       Our deliberations today, not just are debates but the 
     exercise of all our responsibilities--authorizing 
     government policies, appropriating the funds to implement 
     them . . . They can be sincere and principled, but they 
     are more partisan, more tribal more of the time than at 
     any time I can remember. Our deliberations can still be 
     important and useful, but I think we would all agree they 
     haven't been overburdened. . . . Right now, they aren't 
     producing much for the American people.
       Both sides have let this happen. Let's leave the history of 
     who shot first to the historians. I suspect they will find we 
     all conspired in our decline, either by deliberate actions or 
     neglect.

  Listen to John McCain:

       Our system doesn't depend on our nobility. It accounts for 
     our imperfections and gives an order to our individual 
     strivings that has helped make ours a most powerful and 
     prosperous society on Earth.

  Listen to us:

       Let's trust each other. Let's return to regular order. We 
     have been spinning our wheels on too many important issues 
     because we keep trying to find a way to win without the help 
     from [the other side]. That is an approach that has been 
     employed by both sides: mandating legislation from the top 
     down, without any support from the other side . . . We are 
     getting nothing done.
       All we have really done this year is to confirm Neil 
     Gorsuch. . . . I voted for the motion to proceed to allow 
     debate to continue and amendments to be offered.
       I will not vote for the bill as it stands today.

  I will not vote for the bill.

       We have tried to do this by coming up with a proposal 
     behind closed doors in consultation with the administration--

  Donald Trump--

     then springing it on skeptical Members, trying to convince 
     them it is better than nothing . . . asking us to swallow our 
     doubts and force it past a unified opposition. I don't think 
     that is going to work in the end and probably shouldn't.

  Well, this shouldn't work either. This shouldn't work either. This is 
wrong. This is wrong.
  I see the leader here. I am sorry, sir. I should be conserving my 
energy.
  Mr. SCHUMER. Would the gentleman yield for a question?
  Mr. BOOKER. I would yield for a question while retaining the floor.
  Mr. SCHUMER. First, your impassioned remarks are so meaningful. I 
hope all of America is watching. If some people are not up at this 
hour, watch it tomorrow. It is inspiring.
  And I would just ask my colleague a question. I was there. I spent 4 
hours with John McCain before he voted. We talked and talked and talked 
and went over the courage of his father and his grandfather in the Navy 
and the courage that he hoped to show, as they did.
  I ask my colleague this question: Isn't it eerily reminiscent that 
after John McCain did his courageous act, that here we are years 
later--almost a decade later, a few years less--and they are doing the 
same thing again, cutting people's healthcare to give tax breaks to the 
wealthiest people? Isn't it true that John McCain saw the suffering of 
people who wouldn't get healthcare and urged people to come together on 
a bipartisan solution? Wouldn't it be much better if our colleagues 
from across the aisle--they may not agree with us on everything--but 
instead of trying to jam another bill down our throats like they did 
back in 2017, came and worked with us for the betterment of the 
country, for the betterment of the 80 percent of the people who need 
healthcare, who will struggle without that healthcare?
  Some will be ill, some will die--will die--so does it strike the 
gentleman

[[Page S1951]]

that how could the people on the other side of the aisle try to do this 
again after John McCain made such a courageous stance. It is not 
echoing. It doesn't seem to be echoing in their ears, is it?
  I ask my colleague just to answer that general line of questions.
  Mr. BOOKER. Collins, Murkowski, and McCain, I think, took a lot of 
courage. They were getting a lot of pressure from the White House. John 
McCain was viciously attacked afterwards. But his private conversations 
with Members and you, Senator Schumer--I know at the last lap around 
his track of life, he didn't want to be remembered as someone doing 
something--to use John McCain kind of language--boneheaded; to hurt a 
lot of innocent, fragile people and leave them without a plan. When his 
own Republican Governor--I read Republican Governors earlier who were 
saying, don't do this.
  I want to say something else to the Senator in response to his 
question. I watched you that night, and I just loved something you did. 
I never said this to you. People over here tried to start applauding 
and you stood up angry and told them not to because what John showed 
was something bigger than partisanship. He talked about it, one side 
trying to win; it is more ego sometimes than it is ideals. And you 
stood up and said, no, this is not that moment. We are watching a man 
take a position that was not easy. It didn't serve his politics but 
served his spirit.
  I don't know if my staff has the envelope of the article I want, 
specifically because there is a story in there--I don't have it now, I 
will read it later--about John McCain in the prison camps.
  I wasn't here when we had this moment. But when I got here weeks 
after this moment, Mr. Leader, all my colleagues on both sides of the 
aisle talked about a special conference in the Old Senate Chamber. I 
was not there, but the Democrats and Republicans--it actually changed 
our behavior in here. It didn't last. But I came here and people said, 
because of that, we were all going to partner up, and for State of the 
Union Addresses, you have a Republican partner and Democrat--we would 
go as couples, basically.
  Mr. SCHUMER. I remember.
  Mr. BOOKER. It was something about this man where the dignity that he 
had that we all treasured, in a moment like that, he began to elevate.
  I had my partner Senator here say to me when I got here: You are not 
a full Senator until you get ripped by John McCain's anger.
  Mr. SCHUMER. Will the Senator yield? I am well aware.
  Mr. BOOKER. And I never got ripped by him. After my meeting, I 
mentioned earlier in his office, he started inviting me with him. My 
first codel was with him. He told me all the time: Booker, there are 
two types of Senators here. I don't mean to cast any aspersions on 
others, but there are people who represent their States, and there are 
statesmen. He kept challenging me to be a statesman, not a great 
Democratic Senator but to be a great American Senator. He would 
challenge me over and over and over again.
  I would go to his national security conferences out at his ranch. One 
of my favorite moments as a Senator--if I have my top 10 favorite 
moments as a Senator, this is one of them. The leader knows that I am a 
vegan, and when you go to one of his open barbecues, there is nothing 
vegan. I mean, they even saturated every vegetable in butter, and 
mayonnaise was everywhere. But I am not going to complain. I am just 
going to sit and enjoy conference conversations.
  So now I am in a golf cart, going home at the end of the night, and 
the young man who was shuttling me home goes to me: How was the food? 
Did you enjoy the dinner?
  I go: Well, actually, if I am going to be honest, I didn't eat.
  They go: You haven't had dinner?
  I go: No. I am a vegan.
  They go: Well, we are about to pass John McCain's home, where he 
lives, and I am sure it is late, and I am sure he is asleep, but maybe 
we can break in and see what is in his fridge.
  And I am like: Dude, I am from New Jersey. I love this. Breaking into 
John McCain's house, and I won't have to worry about getting arrested? 
I am all in.
  And so we went in, and as soon as we looked around in the kitchen, I 
looked through the kitchen, and John McCain was sitting there with 
another elderly, tough-looking man on the couch, engaging in some 
conversation. So I didn't get my joy of breaking into John McCain's 
house, but I walk in, and he is sitting there with a former Secretary, 
if I remember correctly, of the Navy.
  And they were like: Booker, skedaddle. We are going to have a 
meeting.
  So I am sitting there, eating peanut butter and, like, celery or 
whatever, and these two men are talking about government inefficiency. 
They say the place that we could be saving the most money--the former 
Secretary, if I remember correctly, of the Navy and one of the great 
men on national security. They started detailing the waste in the 
military. They both claimed that we could have much more capacity and 
greater military effectiveness for billions and billions and billions 
of dollars less.
  I will never forget. Again, this is me new to the Senate. I don't 
know foreign policy like I do 12 years later or the military like I do 
12 years later, but I was listening to these two experienced men 
complaining about the gross waste that was undermining our overall 
effectiveness and efficiency. That is why, to this day, I am infuriated 
that, when people come in and say they want to cut budgets, the first 
thing they want to go for is not to have a real conversation--because 
the military hasn't passed an audit in years--about a lot of the baked-
in corruption and misspending in the military, but they are going after 
programs that hospital after hospital, that healthcare provider after 
healthcare provider, that leader after leader, and that Governor after 
Governor says: Are you crazy?
  So this is one of the more preposterous moments. You and I both know, 
if John McCain were here right now, he would reject this whole thing 
because we were literally repeating the same thing we did in 2017, 8 
years ago.
  Mr. SCHUMER. Would the Senator yield for a question?
  Mr. BOOKER. I will yield for a question while retaining the floor.
  Mr. SCHUMER. Isn't it true, when McCain talked about waste in the 
military, he studied it; he documented it; he said this is a good 
thing; this is a bad thing? He helped guide me on many of these things. 
I voted for some weapons systems, getting some people upset because he 
showed me they worked, and I voted against a lot of them because he 
showed me they didn't.
  But isn't it so that our colleagues on the other side, when they talk 
about waste in the healthcare system, they don't document a thing? They 
use just a meat-ax or a chain saw, as Elon Musk perversely but proudly 
said he is going to carry one. They don't document the waste that they 
say exists. They just slash things that people need that is not waste 
at all but that is life support for people. Isn't that a huge 
difference between the way McCain looked at waste, whether it was in 
the military or anything else, and what we are hearing here today?
  Mr. BOOKER. Resoundingly, yes.
  I am just laughing that every time DOGE puts up their supposed 
savings, they then try to take them down because, as soon as they are 
fact-checked, so many of them are not done. And I don't want to say all 
of them. I don't want to paint that broad a brush. I know about having 
Microsoft licenses, too many. Yes, there is waste. I wish we were doing 
this in a bipartisan way. Those cuts would be bigger and probably have 
a lot more staying power than what they are doing, which is ready, 
fire, aim, and then having to beg people to come back to work because 
they fired FAA people or nuclear regulators or what have you.
  But this is the bigger point that you are making that really is 
getting me: So you know this. I used to be an executive. There is 
nobody in this body--here is a bold, bold, braggadocious thing to say, 
but fact-check me, anybody. There is nobody in this body who was a 
Governor, a county executive, like Coons or a mayor who cut government 
as much as I did. I had to cut my government by 25 percent. Imagine 
that here at the Federal level. I had to do it because I couldn't print 
money. It was a national recession. I was left with a mess. I had to do 
it, but we

[[Page S1952]]

found ways to do it cooperatively with the legislature and bringing in 
experts.
  But this is the point I want to make to you: One thing I couldn't cut 
were my healthcare costs. So I started asking people: What can I do?
  Do you know whom I found? I found a big business owner, with tens of 
thousands of employees, who said: I had the same problem, and do you 
know what I did? I went into my cafeteria where thousands of people 
eat--a big, big place--and I saw deep fryers and, like, Cinnabon-like 
products and all this unhealthy stuff, and I ripped it all out and had 
the union ready to go crazy on me, but then I brought in the best chef. 
I paid extra money to get the best kind of all healthy, nutritious 
whole foods. Then they loved it, and then they started asking me: Can 
we get food to take home for our kids? Because we stop at McDonald's 
and Burger King on the way home. Long story short, he said it began to 
bend their cost curve.
  What are we doing in the United States of America? What has Donald 
Trump--I just read all he is doing. He is cutting access to healthy 
lunch programs. He is cutting--they are threatening to cut the SNAP 
program. They are cutting the things that give our residents in America 
not the cheap, hyperprocessed, empty nutrition foods but the stuff that 
is healthy for our kids.
  There is so much hypocrisy based in this that even the private sector 
folks are saying: You are going to drive up costs for your country when 
you make people get their healthcare in emergency rooms. You are going 
to drive up costs for your country when you are going to force people 
to have to quit their jobs so they can come home and take care of their 
loved ones with dementia. This will drive up costs, ultimately, for our 
country and put more hardship on people, all while giving the most 
wealthy people who don't need it bigger tax cuts. It makes no sense, 
and that is the spirit of why John McCain voted against this effort in 
2017.
  (Mr. CURTIS assumed the Chair.)
  Mr. SCHUMER. I thank the Senator. There is a hope--it may be 
forlorn--that maybe one of John McCain's words will influence a few 
folks over there before we proceed disastrously.
  I wish the Senator strength, and I yield the floor to him.
  Mr. BOOKER. I appreciate your allowing me to yield to you to answer a 
question while retaining the floor.
  I am going to continue with a little bit more here before we change 
topics for the night.
  I want to point out how grateful I am for my friend Chris Murphy. The 
last time I stood on this floor for many hours was just in support, 
doing like my colleague is doing for me right now, after the Pulse 
shooting. We wanted a vote on commonsense gun safety--bipartisan-
supported, commonsense gun safety. We didn't get it. Chris Murphy, who 
is right down there, held the floor for 15 hours. I paced around, 
walked the floor, helped to support things, stayed up with him all 
night. So it is profound to me, when I told my brother that I wanted to 
cause some good trouble and that I was going to rise, that he said: I 
am in. I am in. So there he is, helping me out, especially as we 
approach 11 o'clock at night and the fourth hour. I am just grateful 
for him. I am grateful for him.

  I want to go now to cuts that are being made to local and State 
health department funding. Again, from Republican and Democratic 
Governors, we have letters from people on both sides of the aisle who 
are saying that this is just wrong, and it makes no sense, but here we 
go.
  It is actually, really, what I would call a dangerous reversal. 
Trump's HHS recently announced the cancelation of almost $12 billion in 
Federal grants that State and local health departments have been using 
to track infectious diseases, health disparities, vaccinations, mental 
health, substance use and services. Because of that reversal, my State, 
for example, is going to lose $350 million in Federal funding for 
health programs due to these cuts. My Governor, Phil Murphy, said that 
these cuts would create an unfillable void in funding that will have 
disastrous ramifications for our most vulnerable neighbors.
  Last week, we learned that HHS planned to cut an additional 10,000 
jobs. In total, since January, HHS has cut 20,000 of its employees. 
That is over a quarter of its workforce. These are people who inspect 
nursing homes to ensure that they are safe. They approve diagnostic and 
treatment services for children. They regulate health insurance to make 
sure that they are not discriminating against you based on your health 
conditions and health status. They protect you from infectious 
diseases. They conduct inspections to make sure that infant formula is 
safe.
  I want to tell you that Secretary Kennedy has committed to bringing 
radical transparency to the HHS. I would love radical transparency, but 
at the end of February, Secretary Kennedy announced that HHS is no 
longer required to undergo the public comment period--a practice that 
has taken place at the Agency since 1971.
  Another critical resource of health information for the American 
public is the CDC's ``Morbidity and Mortality Weekly Report.'' It has 
been published since 1952 and is often called the voice of the CDC. 
Unfortunately, on January 23, for the first time since its inception, 
the report was not published in a direct response to the Trump 
administration's freeze on public communications.
  In addition to pausing the critical publication, it also reported 
that the Pregnancy Risk Assessment Monitoring System had halted 
operation. This PRAMS, which was developed in 1987, is designed to 
identify groups of women and infants at higher risk of health problems 
to monitor changes in health status, to measure the progress toward 
goals, and improve the health of mothers and infants. Over the last 38 
years, the program has collected essential data on maternal behaviors 
and experiences before, during, and shortly after pregnancy. Maternal 
care providers rely on that data collected by PRAMS--the sole source of 
this type of information--to enhance prenatal and postnatal care. The 
United States is in the midst of a mortality crisis, which we mentioned 
before. We have the highest rate of maternal deaths of any high-income 
nation.
  As I learned when I was a mayor, data is power. You can't manage a 
problem unless you have measures on the problem. If you pull back 
things like that, again, you are reducing transparency, and you are 
cutting back on vital reports that people who are trying to meet this 
crisis rely on to inform their strategies.
  Again, the frustration is that we are the worst in maternal health 
outcomes for developed nations, but even in our country, African-
American women are three times more likely to die from pregnancy-
related causes than the majority. This is one of the countries where it 
is profoundly dangerous to have kids.
  Again, this is yet another thing that HHS is doing. It is leaving us 
more vulnerable, less informed, and less empowered to deal with the 
health challenges that we still deal with.
  Since the Trump administration made the disastrous decision for 
Agencies to pause external communications, we have been seeing 
significant delays in critical information from other key Agencies.
  There have been avoidable delays in critical data from the CDC so 
that States are starting to speak out, saying that they need to protect 
the health of their communities. As of March 20, when it comes to 
vaccines, what we are seeing in America--talk about getting less safe--
there were 378 confirmed cases of measles throughout the United States. 
As one of my doctor friends said, there are more children with measles 
right now than there are trans athletes in the NCAA.
  This is a real crisis. For the first time in a decade, a child who 
was not vaccinated for measles tragically died in that outbreak. And 
while measles is spreading across our Nation and we are having one of 
the worst flu seasons in the last decade, HHS has delayed the convening 
of critical advisory councils of the CDC and FDA. These advisory 
councils are responsible for determining the vaccine schedule--what 
vaccines must be covered by insurance--and the safety, effectiveness, 
and appropriate use of vaccines. They do essential and timely work to 
keep people safe, and disruptions to their work can be harmful to the 
health of American people.
  Let me go to the National Institutes of Health. It is the largest 
public funder of biomedical research in the

[[Page S1953]]

world. It is facing devastating cuts. The NIH is one of the greatest 
successes in publicly funded scientific research in all of human 
history. The United States is one of the best places to do scientific 
research because it has had more capacity than any other country to 
fund and conduct research at the highest levels.
  Pauses, lapses, and elimination of NIH funding will drive researchers 
to do their research in other countries and undermine the efforts to 
cure diseases, to find solutions to conditions from obesity, to 
Alzheimer's, to cancers. One of the best taxpayer dollars we can invest 
is in NIH because it returns more than 5 taxpayer dollars back in the 
breakthroughs that they make.
  We have put the future of scientific research in the United States at 
grave threat with what the Trump administration is now doing. They have 
imposed cuts and a number of harmful orders on the NIH that have both 
stalled its research and confused its partners.
  Now, 99.4 percent of the FDA-approved drugs come from the NIH-funded 
research. Let me just say that again. NIH-funded research has led to 
99.4 percent of all the FDA drugs that are out there.
  The NIH funding cuts will directly affect your access to future novel 
treatments that can improve the quality of life for your children or--
if you love your neighbor like so many religions call us to do--your 
neighbor's children as well.
  Here is an example of that. Hepatitis C is a liver disease caused by 
the virus HCV, and it is one of the most common types of viral 
hepatitis in the United States. It is estimated that 3 to 4 million 
Americans have hepatitis. In 2014, the first complete treatment for 
hepatitis C was approved by the FDA. The development of this 
revolutionary new treatment that has since been used to cure millions 
of people around the world was funded by--you know--NIH research.
  This is the type of lifesaving innovation we will lose out on if we 
defund the NIH as the Trump administration is currently doing. American 
enterprise and knowledge will be drained. We will fall behind.
  We already know there is fierce competition for the researchers by 
countries like China. They are aiming--in fact, they are upping their 
investments in scientific research, doing everything they can to keep 
scientific researchers in their country.
  I was just talking to an innovator out on the west coast who was 
telling me that they are starting to take passports away from their 
researchers.
  There is a fierce competition going on to keep the best minds here in 
this country or be drawn away to other places, from Europe to China. 
And we are stopping our funding?
  I have heard from academic institutions that are telling me that they 
are not even offering as many Ph.D. programs in some of these key areas 
of science because of the attacks that are happening on our 
universities, all while China is upping their investments in 
universities. I can't believe that they are trying to out-America us 
and we are trying to turn our backs on our most successful traditions.
  In one of his first actions, President Trump imposed a communications 
freeze on all U.S. health Agencies, effectively silencing some of our 
Nation's top researchers, scientists, and public health experts. This 
action stalled 16,000 grant applications for around $1.5 billion in NIH 
funding. The NIH has since begun to incrementally send notices to the 
Office of the Federal Register to resume reviews.
  The combination of these actions has irresponsibly stalled our 
Nation's primary source of lifesaving biomedical research. It is our 
understanding that full communications have not been resumed and that 
it continues to impede critical research at the NIH.
  As I have been told time and time again by experts in this area, just 
to pause funding could set research back years because, when you are 
conducting research, whether it is in a test tube, a biomedical 
researcher can't pause; or whether it is a human body, in biomedical 
research, you can't pause.
  Across the Nation, brilliant researchers have been finding out daily 
the Trump administration has canceled their research--research on 
critical issues like maternal health, long COVID, diabetes, new 
pharmaceutical drugs, cancer, and so much more.
  The NIH has decided to cancel its 2025 summer internship program. On 
average, 1,100 interns participate in this program each year, helping 
develop the next generation of scientists and researchers. A small 
number of summer interns had already accepted their offer to join the 
NIH in 2025. The decision follows the Trump administration's Federal 
hiring freeze.
  Again, in my faith, as I said, you train a child in the way he shall 
go, and he will not depart from it. These are our young people. These 
are the future scientists who now aren't getting the experience of a 
lifetime. I have met people in this institution who first came here as 
college summer interns.
  The NIH has decided not only to cancel those internships but to shut 
the door to many kids who had already made their summer plans. Many 
people here know what it is like to have a summer plan, have a summer 
internship, and not apply for other ones. It is another act of just 
meanness and cruelty. Let this class come in and then say: OK. I am 
going to cut the program next year.
  But the way they are doing things is mean and cruel and is having an 
impact on people's lives.
  Congressionally directed medical research programs--I have worked 
across the aisle with my colleagues. I have friends in here that have 
worked with me on specific diseases in a bipartisan way. I am so proud 
of some of that work.
  Well, we have long appropriated about $1.5 billion a year in Federal 
funds for medical research, nearly half of which typically goes to 
cancer. It is something that we have found common ground on in my 12 
years here in significant stretches.
  The medical research program was created and sustained by Congress 
and competitively awards funds to hundreds of projects each year at 
both the Defense Department labs and outside research institutions, 
including at many American universities, to study everything, again, 
from cancer, to battlefield wounds, to suicide prevention.

  In 2024, $130 million was specifically appropriated in a bipartisan 
way in this body--incredibly good Senators of good conscience coming 
together and saying: We should do more in these areas.
  They approved $130 million for research in breast, kidney, lung, 
melanoma, ovarian, pancreatic, prostate, and a handful of very rare 
cancers. Why? Because there are people of good conscience here.
  We meet folks who come to this--not lobbyists. They come and they 
tell us about their stories of rare cancers. There are people on both 
sides of the aisle who have marched for prostate awareness, for breast 
cancer awareness. There is goodness and decency here.
  But in 2024, this funding--it is a bill that passed in March. It was 
now slashed--slashed--by 57 percent. And I told you earlier, that 
data--one of the best taxpayer dollars we can spend is in medical 
research. We have all heard this in this body when the NIH has come 
through and has shown that $1 invested and you get more than $5 back. 
Any Wall Street executive that would get five times their money back 
from an investment--who is this helping? And do we think about the 
people?
  I thank God I don't have any family members that are going about 
their day, go to the doctor, and come back with cancer. I know lots of 
people, though. I know their stories, when they are diagnosed with a 
cancer and they are told there is no cure. I have seen people go 
through what you go through with that.
  So how could a country that has led humanity for more than a 
generation or two suddenly have a President come along and say: I am 
going to slash all of these things. Oh, by the way, I am going to give 
billionaires a big tax cut.
  So what do we say when these folks come to our offices? Some of the 
people with rare diseases came to my office a couple weeks ago. And the 
amount of their funding is so small. And maybe--maybe--if it was to 
solve our budget deficit. If we are going to do this as a country, we 
have to come together in a bipartisan way. The debt is--I am one of 
those Senators who believe it is a real crisis. But we are not solving 
the deficit in what they are proposing here.

[[Page S1954]]

They are cutting and cutting and cutting things that make no sense to 
cut, and they are doing it for tax breaks which disproportionately go 
to the wealthiest and to rack up even more debt.
  I want to read this article. My staff told me that we have lots of 
sections to go through, and it has been 4 hours, 11 minutes. But this 
is one that hurts me because I have met so many people who fall into 
this category. I want to read an article that deals with an issue 
called medical debt and the ongoing impact it has on people as part of 
their lives.
  The Affordable Care Act--when we did that, we lowered the costs and 
implemented protections for Americans, requiring insurers to cover 
preexisting conditions; expanding Medicaid, which we have talked a lot 
about tonight; implementing caps on out-of-pocket costs for Americans. 
All of these helped in alleviating medical bankruptcy for some.
  Medical bankruptcies in America have gone down but not all. We still 
live in a country where one of the top reasons for bankruptcy is 
medical debt.
  One of my staffers kind of shook me with the reality she was dealing 
with, which is she has stratospheric medical debt.
  So here is an article from Healthcare Insights. It is not a partisan 
rag; it is a scientific journal. ``How Medical Debt Is Crushing 100 
Million Americans.'' It is from October of last year.
  This author--I just want to give a little more understanding of what 
kind of article this is--is John August. He is the Scheinman 
Institute's director of healthcare.

       George Curlee is one of 52 million people or 1/3 of 
     Americans in the workforce who earn $15/hour or less.
       I had the opportunity to interview George recently about 
     his experience with medical debt and how it has impacted his 
     life. Having suffered an industrial accident, and even though 
     his employer was responsible for his injuries and he carried 
     health insurance, he still accumulated $20,000 in medical 
     debt.
       George grew up near Dallas, and spent his life working hard 
     as a full-time warehouse and retail worker.
       At one point in his life, he found a job he enjoyed as a 
     fork lift driver in a factory that produced ceramic tile. In 
     time he switched jobs, working on the production line. One 
     fateful day a piece of metal struck him in the foot. He had 
     to have surgery and underwent the amputation of one of his 
     toes.
       He had to take a month off of work, and when he returned he 
     went back to driving the forklift truck. He found that due to 
     his accident and surgery, he could not operate the forklift 
     to his satisfaction. He became frustrated with not being able 
     to operate the forklift, grew depressed, and left the job.
       ``It took me three months to get back on my feet after the 
     toe amputation. There was nursing care for two months to help 
     me walk again. This life saving medical procedure left me 
     with over $20,000 in debt, even with insurance!
       I avoided doing [necessary] follow up with doctors due to 
     not being able to afford additional needed care.
       There were hard times on top of this. I suffered a great 
     deal of depression due to losing my job during my leave of 
     absence. This medical debt is currently following me. There 
     was a point of time that I was rebuilding my credit. Before 
     the surgery, I built it up by over 120 points. With this 
     medical debt on my credit report, my credit score dropped 60 
     points.
       The big drop in score has not allowed me to get my own 
     place. I'm not able to continue to pursue my dream of being a 
     voice actor due to not having proper financial footing to get 
     back to school. I can't travel and do things I would like to 
     do. I am working, but things are very financially tight. The 
     medicine I need is being paid out of pocket.
       After paying my bills, I am in the negative. There is no 
     money left over to pay my medical debt. I can't save money 
     right now, not even towards retirement. To have this medical 
     debt on my credit score means not being able to pursue a 
     better life.''
       He went on short-term disability for a while, but then 
     found a part time job he holds now at Walgreen's. He had to 
     return to work to pay for the house he and his brothers had 
     purchased.
       Through this period, George had to take payday loans. 
     Between those loans and his weekly wages, he attempted to pay 
     back the money he owed the hospitals.
       He learned that because of his medical debt, his credit 
     rating was destroyed by credit agencies who learned that he 
     had fallen behind on his payments to the hospitals.
       According to the Consumer Finance Protection Bureau--

  Which I guess barely exists now--

     100 million Americans owe $220 billion in medical debt.

  So ``100 million Americans owe $220 billion medical debt.''

       George told me that the medical debt has had several 
     devastating impacts on his life:
       Inability to borrow money for a mortgage or a car.
       Employees ask for credit reports, and reports that show an 
     applicant for a position are often rejected due to a poor 
     credit report. This has impacted his ability to find a better 
     job than his part-time job at $15/hour with no benefits 
     working at Walgreen's where he lives in Garland, TX.
       Incredible stress that further impacts his health 
     conditions including diabetes. (An additional note: Garland, 
     TX, where George lives, is near Dallas. Tarrant County, which 
     includes Garland and Dallas, is a locality with high medical 
     debt and high profit for healthcare systems in the region.)
       Though George makes very low wages, medical debt is a 
     broadly shared experience by Americans across income groups. 
     Clearly, low-wage workers suffer a worse burden, but the 
     problem is pervasive and a broad feature of American life.
       Some background.
       In the oft-sited study, as many as 66.5% of people who file 
     for bankruptcy blame medical bills as a primary cause.

  I am going to repeat that in the article: 66.5 percent of Americans 
``who file for bankruptcy blame medical bills as their primary cause.'' 
Two-thirds of Americans who are filing bankruptcy point to medical 
bills as the cause.

       As many as 550,000 people file for bankruptcy every year 
     for this reason.

  More than half a million Americans, year after year after year after 
year after year after year, for no fault of their own--because of a 
metal bar shoved up through his toe, because of a diagnosis of cancer, 
because of diabetes, because of things outside of their control--they 
rack up medical debt that, as this man, can erode their well-being.

       This data has been known [about how many Americans are 
     affected] and has continued with the passage of the 
     Affordable Care Act.
       Lesser known is the amount of medical debt that Americans 
     carry.
       What are the causes of the burden on so many?
       While more Americans have health insurance today than ever 
     before, coverage has many gaps. High deductibles and narrow 
     networks which prevent patients from seeking health providers 
     of their choice are common causes of accumulation of high 
     cost bills. When patients understandably seek care from a 
     preferred provider, too often that care is not covered.
       Most healthcare plans only provide 80% of payment for 
     covered cost. 20%--

  Twenty percent--

     patient responsibility of high medical bills can leave people 
     unable to pay their bills.
       Approximately 14 million people in America (6% of adults) 
     in the U.S. owe over a $1,000 in medical debt and about 3 
     million people (1% of adults) owe medical debt of more than 
     $10,000.
       Additionally, this government report identifies many of the 
     components of medical debt which are completely out of 
     control of the patient. In most cases these practices are 
     unlawful, but hospitals use these tactics frequently to press 
     patients to pay, including:
       Double billing: Companies cannot attempt to collect on 
     medical bills that have already been paid by the consumer, 
     insurance, or a government program such as Medicare or 
     Medicaid. This practice can coerce consumers into paying 
     twice for the same service.
       Exceeding legal limits: Companies must attempt to collect 
     amounts that surpass federal or state caps, such as those set 
     by the federal No Surprises Act or state laws on 
     ``reasonable'' rates. These violations can saddle consumers 
     with unjustly high medical debts, burdening their finances.
       Falsified or fake charges: Debt collectors must not collect 
     on bills that include ``up coded'' or exaggerated services, 
     or charges for service the consumer did not receive.
       Collecting unsubstantiated medical [debts]: Debt collectors 
     must not attempt to collect medical debts.

  These are all awful practices that go on.
  Here is Paul Sugar's story, compelling and tragic.

       Paul spent much of his life, starting as a child, learning 
     about jewelry, living in a small town near Albuquerque, NM. 
     At an early age, he earned enough money selling silver and 
     turquoise necklaces to be able to buy a motorcycle. As he 
     became an adult, he developed a successful business in the 
     mining and selling of silver and turquoise used in making 
     jewelry.
       He also worked at a GE engine plant, but was laid off 
     during the time of industrial downsizing. He also [went] to 
     work for Quest, installing communications infrastructure, but 
     was laid off from that job when Quest was acquired by US 
     West.
       So, he returned to his business.
       On January 9, 2019, he was terribly injured in a fire in 
     his home. He is still recovering physically and economically. 
     After losing 66 percent of his skin and getting care at a 
     specialty trauma unit in another part of the country, he 
     ended up owing over $82,000 in medical bills. The medical 
     debt on his credit

[[Page S1955]]

     report means he has not been able to get loans to expand his 
     business and earn more. After the fire, his medical bills 
     [totaled] $550,000.
       Insurance covered most of it, but it was still more than he 
     could pay. He made payment plans with all of his various 
     bills, but when his credit card number changed, some of the 
     automatic payments he had arranged for did not go through, 
     and the bills ended up in collection before he even knew he 
     was behind.
       Prior to the fire, he had always had a stellar credit 
     rating, but since this medical debt, it has gone down. In his 
     business, it is important to be able to take out short-term 
     loans to resupply the company, but now he can't do that at 
     reasonable terms and rates. He spent his retirement savings 
     account trying to pay back all his medical bills--

  His retirement savings--

     but it wasn't enough. Now, he worries about his future. How 
     will he retire? Will he have enough for his daughter's 
     college education? Can he move homes if he needs to?
       At one point, he needed to replace his car because he and 
     his wife had to travel in 18 hours round trips every couple 
     of weeks to receive prescriptions for pain medication. He was 
     denied the credit to do so.
       Our Health Care Professionals are on the Frontlines of 
     Impact of Medical Debt.
       Doctors and other healthcare professionals experience 
     firsthand when patients are denied care due to medical debt. 
     This article describes how healthcare systems deny patients 
     with medical debt.
       Dr. Matt Hoffman, who is a leader in the successful effort 
     to form a union with Doctors Council in 2023 [talked about 
     this problem.]
       [They] instructed staff to stop providing care to patients 
     more than $4,500 in overdue bills, going beyond the more 
     common practice of turning such debts over to collection 
     agencies.
       He and his follow doctors protested their health system's 
     decision to deny the patients access to care due to medical 
     debt. Minnesota Attorney General Keith Ellison banned the 
     denial of care for patients . . . [with] medical debt.

  I mean these practices sound like they are Byzantine. They sound 
like--they don't sound like America or at least who we should be.
  There are a lot of New Jerseyans who are dealing with medical debt. 
There are a lot of New Jerseyans who are being impacted by these 
programs that the President has already rolled back.
  I am standing today because of this crisis in our country, and one of 
the strategies that Donald Trump and ]his team talked about is to flood 
the zone--flood the zone, flood the zone. So sometimes the press 
doesn't even cover the cutting of some of these programs, some of these 
benefits that help people who are struggling with medical debt or 
struggling to make ends meet, to help them access healthcare.
  It is a level of distraction and cruelty. Again, why? Why are they 
cutting this? They are saying they are trying to make government more 
efficient or more effective. Well, it is not effective for these folks.
  What are the savings going to go to? Is it going to go to expanding 
medical research, expanding those things that, when the taxpayers 
invest money, they get a return? No. They are cutting medical research. 
They are cutting the things that empower children to grow up and have 
healthy, productive lives. And again, what they are aiming to do with 
it--what they are aiming to do with it--is to provide massive, massive 
tax cuts.
  I am coming to the end of this section, but there are more voices 
that I want to include. I want to read a few, and then I think I am 
going to get a question from my colleague. So a few more pages, if I 
may, before we begin to dialogue--or at least I will receive a 
question, I imagine.
  I want to elevate some of these voices.
  This is a person writing to me in February 28:

       Dear Senator Booker, I am writing to you as a concerned 
     citizen, most importantly as a proud aunt of a Ph.D. in 
     neuroscience, dedicating her life to research that could lead 
     to lifesaving treatments.
       As a minority in science, she has worked incredibly hard to 
     break barriers in a field that has not always welcomed people 
     like her.
       Watching the current political attacks on research funding 
     is not just heartbreaking; it is dangerous for our country's 
     future.
       Science is not political. It serves all people, regardless 
     of race, background, or party affiliation.

  Yes, funding cuts to Agencies like NIH and the National Science 
Foundation threaten to halt critical research, slowing the development 
of treatment for diseases that impact millions. These cuts will push 
out brilliant young scientists, many of whom have already had to fight 
to get where they are to do the research they are doing.

       This is not just about my niece or scientists in general. 
     It is about every American. Disease does not choose a 
     political party. Cancer, Alzheimer's, Parkinson's, and 
     countless others affect Republicans and Democrats alike. 
     Without strong investment in research, we are all at risk of 
     losing the chance for better treatments, new cures, and 
     improved healthcare.
       Beyond health, defunding science will hurt our economy. 
     Scientific research drives innovation, creates jobs, and 
     ensures that the U.S. remains a global leader.
       A country that does not invest in science is a country that 
     falls behind.
       I urge you to continue standing with the scientific 
     community, supporting young researchers from all backgrounds, 
     and fighting to protect and expand research funding. This is 
     one of the most critical investments we can make for health, 
     for economic growth, and for the future of every American.
       Thank you for your time, leadership, and dedication for 
     building a stronger, smarter, and healthier Nation.

  A couple of New Jersey sources--this is a letter from someone in 
Somerset, NJ:

       At my university, I am extremely concerned that we are not 
     as large an institution as some of the others and do not get 
     as much State aid. We rely on these funds for more than 
     running facilities.
       If this goes into effect, it will ultimately lead to the 
     loss of jobs, research, opportunities for students, and will 
     stunt our growth as we embark on a journey to become an R1 
     institution. I am not sure we can recover from this anytime 
     soon.

  Another person on these cuts to the NIH:

       I am a postdoctoral researcher performing basic science 
     research on bacterial communication. In short, I am seeking 
     to understand bacterial chemical communication to find new 
     pathways for therapeutic development.
       Antibiotic resistance is already killing thousands of 
     Americans each year. We need new treatments provided by 
     indirect costs to find these cures.
       Indirect costs, actually, directly funded my day-to-day 
     work, providing funds for building maintenance staff, 
     university shared resources, such as electron microscopes, 
     and common laboratory supplies, such as liquid nitrogen.
       Without any of these resources, my job and those of other 
     researchers seeking new cures would be impossible. Thus, 
     eliminating or reducing these funds will have negative 
     repercussions on the health and well-being of the American 
     people for generations to come.

  That is my constituent from Plainsboro, NJ.
  Relating to Federal grant fund freezes, another New Jerseyan writes:

       I am a researcher at the University of New Jersey where I 
     study ways to combat cancer and promote infant health, 
     critical research that ensures generations grow into healthy 
     adults. My aspirations align with yours, fostering a strong, 
     healthy, and educated population. For this reason, I urge 
     you, Cory Booker, to take immediate action to restore normal 
     federal grant operations so that my colleagues and I can 
     continue making paradigm-shifting, state-of-the-art 
     discoveries with the potential to save millions of lives.
       This university is dependent upon federal grants, a 
     testament to the world-class quality of our research and its 
     leadership in the biomedical field. These grants enable 
     groundbreaking advancements that position the United States 
     at the forefront of scientific information.
       I had planned to apply for a federal grant in 2025 to 
     further my research, but with the current uncertainty, I am 
     deeply concerned about my application's future.

  Here is another scientist:

       My 5-year NIH grant is in its second year; and although my 
     first-year budget ended and I submitted all the required 
     documents, my second-year funding was cut. We need the 
     funding to be able to continue our critical research.

  Here is another patient story:

       At age 17, a large black spot blocking his vision suddenly 
     appeared in my patient's right eye. Over the next couple of 
     months, multiple trips to increasingly specialized doctors 
     led to a clinical diagnosis of Von Hippel-Lindau disease, the 
     diagnosis received by phone on his 18th birthday. This is a 
     genetic disease in which the damaged VHL tumor-suppressor 
     gene fails to stop tumors from growing. Patients experience 
     randomly occurring tumors in up to 10 organs, and the only 
     available treatment was surgery to try to remove the tumors.
       The patient is one of about 10 percent of patients who are 
     de novo, the result of random genetic mutation. In this 
     patient's case, scans had revealed not only a large tumor on 
     the optic nerve of his right eye but also a huge tumor 
     encompassing one of his adrenal glands that, in retrospect, 
     had been causing him headaches, inability to concentrate, and 
     anxiety due to consistently elevated adrenal levels. While 
     MRI scans also relayed tumors in his spine, kidney, and 
     pancreas, this tumor and entire adrenal gland needed to be 
     removed.
       After months of injections in his eye interspersed with 
     laser treatment, he lost the vision in his right eye. The 
     time needed for

[[Page S1956]]

     medical care required him to give up his team sport, losing 
     both his support group and his chance to compete in the 
     Division I level, but he continued with his final exams, 
     graduation, and plans to study engineering at the university. 
     With continued regular monitoring, he was able to attend 
     university, but the trauma of his diagnosis and the 
     processing of the impact of what it might mean for his life, 
     coupled with the stress of engineering studies, brought on 
     significant mental health challenges.
       He did go on to graduate, traveling to the NIH for his 
     regular surveillance, supported by various specialists. In 
     2022, a kidney tumor had grown large enough that he needed 
     surgery again. The kidney is a sensitive organ and will 
     normally have full nephrectomy of the affected kidney. 
     Doctors were treating him, and now at age 24, his tumor was 
     removed in a successful kidney-sparing robotic operation, yet 
     tumors on his spine continue to grow.
       This experience with my patient and many others 
     encapsulates that the miracle of medical research funding has 
     such a powerful impact on people's lives. We were able to get 
     seriously miraculous things done; but without funding for 
     these diseases, we may never have had a chance to test the 
     ideas and develop them in a way that led to a drug that 
     ultimately helped this patient with these tumors.
       This is a success story, but will we have more? Will we 
     have others? The drug we've developed is expensive. Current 
     recommendations are to take it daily. Nothing is known about 
     its long-term side effects. More research isn't done. It's 
     not known whether patients can take breaks from the drug. 
     Stopping at some point might mean tumors would resume. One of 
     the congressionally directed medical research program grants 
     recommended for FY25 funding is going to look precisely at 
     many of these questions. Two others will examine other 
     aspects of critical treatment.
       These are life-or-death issues for the patients, and yet 
     this funding now is threatened, yet this research now is 
     threatened. Please continue to fully fund the congressionally 
     directed medical program.

  I am going to read a few more and then pause, just in case my 
colleague wants to ask a question.
  But this is Kerry Muller from Texas:

       My family has benefited from congressionally directed 
     medical research programs because my 13-year-old daughters 
     have neurofibromatosis, a rare genetic disease which causes 
     uncontrolled tumor growth. My daughter Kaitlyn was diagnosed 
     with a brain tumor 2 years ago, and thanks to the drug whose 
     research was seeded with a congressionally directed medical 
     research program, her brain tumor has decreased to the point 
     that it is now undetectable on an MRI.
       Without this drug, she would have had to have tried other 
     chemotherapy treatments that would have been more invasive, 
     in addition to brain surgery to bypass the blockage the tumor 
     would have caused.

  This is Samantha Pearson from Las Vegas:

       For just over 4 years, I have been at a clinical trial at 
     UCLA. The meds were just recently FDA-approved. While the 
     side effects have made me question agreeing to the trial, 
     being told my tumors have drastically shrunk made it all 
     worthwhile. My pain has decreased. My plexiform neurofibroma 
     is 90 percent smaller, and I am so happy that I get to be a 
     part of this clinical trial made possible by NFRP because of 
     my participation in the drug trial.

  There is story after story here of people: Camille Oldenburg; Jane 
Dmochowski; Lola Neudecker; Professor Alexander Rabchevsky; Kyle Reitz; 
Karissa Haberkamp from Illinois; Samuel Kirton; Dr. Stephanie 
Buxhoeveden; Katharina Hopp; Jerrod Kerr; Dr. Terry Watnick; Scott 
Howe, Marine Corps retired; Van Stewart, United States Navy; Reid 
Novotny, colonel, Air National Guard; Alex and Lesley; Chip and 
Kristin; Gregg and Molly from Denver.
  William Tuttle, United States Navy:

       After my son's birth and diagnosis, I was diagnosed with 
     tuberculosis sclerosis complex at the age of 43, just 3 
     months after I retired from a 23-year naval career.
       The complexity of this disease means that it remains to be 
     seen whether my young son will be able to live the typical 
     life that I have been fortunate to live. Because of research 
     conducted through the TSCRP, my son has effective treatment 
     options available to him that were not available even just a 
     decade ago. But there is still so much to learn.

  Again, another person benefiting from our research, benefiting from 
the funding that is now being threatened and cut.
  Beth Tinlin from Nevada; Shelly Meitzler; Ron Heffron; David and 
Brooke Carpenter, military family; Major David Long, U.S. Air Force; 
Debora Moritz; Fran Hillier.
  I just want to say that the Declaration of Independence clearly 
states:

       We hold these truths to be self-evident, that all men are 
     created equal, that they are endowed by their Creator with 
     certain unalienable Rights, that among these are Life, 
     Liberty and the pursuit of Happiness.

  How can you have life, liberty, and the pursuit of happiness without 
health? Health is at the core of life. Health is at the core of true 
liberty. Health is at the core of the pursuit of happiness.
  The right to health is fundamental for overall well-being and for the 
realization of other human rights. In his annual State of the Union 
Address to Congress on January 6, 1941, President Franklin Delano 
Roosevelt underscored the importance and shared commitment to four 
freedoms. Many of you know them.
  The first freedom is freedom of speech and expression; the second is 
the freedom of every person to worship their own way; third is the 
freedom from want, which means every person deserves peace and health, 
among other things, he said. The fourth freedom is a freedom from fear, 
which in our country of great wealth, no one should fear their 
healthcare going away.
  We have known from our country's beginnings and throughout that we 
must do all we can to provide for our people, and we have tried to do 
that over the years from the Social Security Act of 1965, which created 
Medicaid and Medicare, the Health Insurance Portability and 
Accountability Act of 1996, HIPAA, the Patient Protection Affordable 
Care Act of 2010--the ACA.
  We should be adding to these protections and benefits trying to get 
more people health coverage. We should be caring for each other. We 
should be loving each other. We should be fighting for the justice of 
each other. We should be hearing the cries of parents worried for their 
children. We should be hearing the agony of a partner whose spouse has 
Alzheimer's. We should be standing up for these folks. This is why we 
fight. This is why I stand.
  Mr. MURPHY. Will the Senator yield?
  Mr. BOOKER. Yes, I will yield for a question while retaining the 
floor.
  Mr. MURPHY. Senator Booker, first of all, I want to express my 
gratitude to you for recognizing the gravity of this moment. Your 
ability to see that we are facing a series of threats that are not 
normal--a series of threats to families, to children, to individuals, 
threats to our democracy, threats to our rule of law--I think it is 
really important.
  And you have endeavored to do something extraordinary here, to stand 
on your feet for as long as you can to convey both to our colleagues 
and to the public that because these are not normal times, what is 
required of us is something different than a normal response.
  And I know maybe we have extended the amount of time that you had 
planned to talk on this particular topic of the threat to Americans' 
healthcare, but I don't know that there is anything more important that 
we are talking about today in the U.S. Senate because the scope of what 
Republicans are talking about here is absolutely extraordinary.
  And I want to lay out for you, you know, a few additional facts and 
numbers and ask you to respond to them as you wrap up your time talking 
about this particular topic.
  But let me just underscore what you have laid out very well. We are 
talking about nearly $900 billion worth of cuts to Medicaid in order to 
pay for about a trillion dollars' worth of tax cuts for the wealthiest 
1 percent of Americans.
  There will be table scraps in the Republican bill for middle-class 
consumers and families, but the bulk of the tax cuts are going to the 
very, very wealthy--millionaires and billionaires; frankly, people who 
have done tremendously well in this country over the past several 
decades, who are not in need of more.
  And so you were very right to point out the immorality of the 2017 
attempt to cut the Affordable Care Act, which insured 20 million 
Americans. But Medicaid covers 70 to 80 million Americans, and the new 
wrinkle is that this proposal doesn't just cut healthcare for tens of 
millions of Americans; estimates are that it could be 30 million 
Americans that lose healthcare under the Republican proposal.
  No, this is even more difficult to swallow for the American public 
than the 2017 attempt to cut and eliminate the Affordable Care Act 
because this measure is a direct transfer of money from the poor, the 
middle class, the

[[Page S1957]]

people who are on Medicaid to the very, very wealthy.
  Frankly, it could turn out to be the biggest transfer of wealth in 
the history of the country from the poor and the middle class to the 
wealthy, which is why, I think, you are taking this extraordinary step 
to make sure that our colleagues and the American people know the 
gravity of this moment.
  A lot of Republicans all across the country are not doing townhalls 
any longer; they are not meeting in person with their constituents. And 
so there are a lot of Americans that are going to be in the dark that 
have a lot of questions, have a lot of questions about what is 
happening here, about why it is necessary to cut a program like 
Medicaid--that insures 24 percent of Americans--to the bone in order to 
finance a tax cut for the very, very wealthy.
  One of the things I just wanted to set up for you here is, you know, 
just to note that Americans may be surprised to know that 24 percent of 
Americans are actually on Medicaid today, because some Americans may 
say: Well, my insurance isn't Medicaid. My insurance is through 
MississippiCAN. My insurance is through ACCESSNebraska. My insurance is 
through Centennial Care. Or in Connecticut, my insurance is through 
HUSKY Health. In New Jersey, it is New Jersey Family Care, right? So 
Medicaid normally isn't called Medicaid; it is called something 
different in every State.
  So it is important for you to understand that so many of your 
neighbors are on Medicaid even though it may not be called Medicaid in 
your State. That is how we get to 24 percent of American families on 
this particular program.
  The Joint Economic Committee, which is a committee of Congress, did a 
study, issued a report, talking about how many people would lose their 
healthcare insurance on a State-by-State basis if this $880 billion cut 
to Medicaid went through. I won't go through the whole list, Senator 
Booker, but I just pulled out some States that are represented by our 
Republican colleagues.
  In Alabama, 20 percent of Alabamans are on their Medicaid Program. In 
total, 330,000 people in one State--Alabama--would lose their 
healthcare if this cut went through.
  In Arkansas, 25 percent of families are on the Arkansas Medicaid 
Program. A quarter of a million people would lose their health 
insurance.
  In Florida, 17 percent of the State is on Medicaid, and 1.3 million 
Floridians could lose their healthcare because of these Medicaid cuts.
  We can just go on and on. Twenty percent of Iowans are on the 
Medicaid Program, 20 percent of Indiana residents, and 25 percent of 
Kentucky residents. Thirty percent of Louisianans are on their State's 
Medicaid Program, and 500,000 residents of Louisiana could lose their 
healthcare.
  Some of that would happen in a sort of slow-moving catastrophe, but, 
as you pointed out, Senator Booker, a lot of that would happen 
immediately because many of the States that have taken advantage of the 
Affordable Care Act Medicaid expansion have a built-in clause to their 
State's law that says that the minute the reimbursement rate declines, 
even if it declines by only a few percentage points, the entirety of 
the Medicaid expansion program is eliminated. So, overnight, you will 
have millions of people who would lose their healthcare insurance.
  But, as you have rightly pointed out, that is just the beginning of 
the disaster because there are hundreds of rural hospitals in this 
country that are right now living on the brink of disaster. If Medicaid 
reimbursements drop by just 5 or 10 percent, those rural hospitals are 
out of business. The same can be said of thousands of drug treatment 
centers in this country, addiction treatment centers. So you are 
ultimately talking about hundreds, if not thousands, of hospitals and 
health centers closing and millions of Americans losing their 
healthcare insurance. And for what? And for what? To be able to hoard a 
bunch of money so that the richest Americans can buy a third vacation 
home? So that millionaires can double their landscaping budget? Who is 
asking for this in America today?
  Of course there is a conversation to be had about efficiency in our 
healthcare programs, but none of that conversation is happening here. 
If it was, you wouldn't be reading the letters of all of these 
associations representing healthcare groups predicting disaster; they 
would actually be in the room at the table. If you really wanted to 
save money, you would actually put the doctors and the hospitals and 
the medical providers who know something about the system in a room, 
but instead this is a political decision that has been made to cut a 
certain amount of money that does not coincidentally line up to the 
amount of money that the Republican budget bill wants to give in tax 
cuts to the very, very wealthy.
  So you, I think, rightly put emphasis on and drew attention to John 
McCain's decision--and, of course, we should always give credit to Lisa 
Murkowski and Susan Collins, who also voted no in 2017 on the repeal of 
the Affordable Care Act bill--because it is just a reminder that you 
are under no obligation as a U.S. Senator to do the wrong thing if you 
know what the right thing is.
  You work so hard to get this job, spend your entire life working to 
become somebody who can make important decisions like we can in the 
U.S. Senate, and you are under no obligation to outsource your decision 
making to the President of the United States or your party leadership. 
Everybody here gets to make an independent decision on what is right or 
wrong, and this just feels plain wrong--a thoughtless, unplanned, 
massive cut in Medicaid that is going to throw millions of people off 
their healthcare in order to finance a tax cut, the majority of which 
is going to go to people who don't need it. Every Senator here can make 
up their own mind as to whether that is the right thing or the wrong 
thing to do for this country.
  The exercise that you are engaged in, Senator Booker, is a simple 
one: just trying to make sure that all the facts are on the table.
  That last segment you did on the impact on medical research should be 
reason alone for folks to reconsider the path this administration is 
taking. But the Medicaid cuts as a mechanism to further enrich those 
that are already plenty rich--man, I just don't imagine that is 
anything the American public are clamoring for.
  So, Senator Booker, I just wanted to really thank you for standing up 
and making this moment possible. I want to leave you with just two 
stories on this topic that have come into my office and then ask you a 
question. This is all lead-up to a question.
  So I have a constituent who was paralyzed about a decade ago, and he 
now uses a wheelchair, and the only insurance program that can provide 
him with what he needs from a mechanical and technological standpoint, 
plus the drugs he needs to survive, is Medicaid. It is his only option. 
It is his only option. He can't work. He is paralyzed. Medicaid is his 
only option. For him and for millions of others, Medicaid is life or 
death. It is just life or death.
  If you are talking about cutting Medicaid by as much as 20 percent--
that is what we are talking about here today. An $880 billion cut in 
Medicaid represents about 10 percent of the overall program, but you 
have to assume that States are not going to continue to match if the 
Federal Government isn't putting in their share. So that 10-percent cut 
could very quickly become something closer to a 20-percent cut. There 
is no way that you can cut the Medicaid Program by 20 percent without 
it impacting people like my constituent in a wheelchair who comes to 
many of my events when we protest these Medicaid cuts. This is life or 
death for many Americans.
  But that is not the full extent of the horror that will happen. I was 
just reading a letter the other day from an 80-year-old constituent of 
mine who lives at home with his wife, but his wife is very frail, and 
it is Medicaid and Connecticut's Medicaid waiver that allow for her to 
receive in-home healthcare services.
  He is panicked. He wants to spend the final years of his life with 
his wife. He knows that if Medicaid gets cut even on the margins, that 
Medicaid waiver likely is gone, and either his wife will pass or she 
will have to be in an institution.
  Query whether that institution will even be able to give her a place 
because two-thirds of nursing home beds in this country are paid for by 
Medicaid.
  So one way or the other, he is staring separation from his wife in 
the eye.

[[Page S1958]]

She either doesn't make it without the Medicaid reimbursement that 
gives her the services at home or she is forced to go to an 
institution, and they live separately for their final days.
  This is the reality facing people who rely on Medicaid, whether you 
are disabled or elderly. This is the reality that will be imposed on 
millions of Americans in order to finance a tax cut for the wealthy.
  The scope of this is just enormous, Senator Booker. So I guess this 
is the question I wanted to ask you. You and I have been in government 
for a long time. We have served in a variety of different capacities.
  I don't think this country is really ready for the scope of the 
healthcare cataclysm that could come with a trillion-dollar cut to the 
health insurance program that is responsible for the care of one-
quarter of Americans, two-thirds of nursing home beds, and the budgets 
of literally tens of thousands of vital healthcare institutions in this 
country.
  Nobody is better than you at conveying the moral consequences of the 
decisions we make here. Just share with us for a minute, as you sort of 
wrap up a conversation on this topic of the healthcare priorities of 
the Trump administration and the Republican Congress, what America may 
look like in a world where we have decided to gut the health insurance 
program of last resort for the most vulnerable Americans and the health 
insurance program that insures 24 million Americans, two-thirds of whom 
are working for a living. Just give us a little bit of a sense of the 
enormity of the consequence that this ultimately would bring to this 
country.
  Mr. BOOKER. First of all, thank you for the question. But I just want 
to reiterate the friendship I have with Chris Murphy and his 
willingness to spend the night with me here on the floor as we go hour 
after hour after hour. I just want to say this again, and I am going to 
say it a few times in this long speech that will go on for as long as I 
am physically able.
  Chris, the last time we spent 15 hours on this floor together was a 
health issue. It was yet another stunning mass shooting, this time at 
the Pulse nightclub.
  You and I talked a lot before we got on this floor, and I think the 
agony that you and I were feeling was, how can this be the strongest 
Nation in the world, organized government?
  If you read our founding documents, if you read our Founding Fathers, 
one of the first things they organized this government for--you know, 
it is good to carry around the Constitution. It is so important to 
understand what the preamble to the Constitution says we are about.

       We the People of the United States, in Order to form a more 
     perfect Union, establish Justice, insure domestic 
     Tranquility, provide for the common defense, promote the 
     general Welfare, and secure the Blessings of Liberty to 
     ourselves and our Posterity, do ordain and establish this 
     Constitution for the United States of America.

  Which each one of us, each one of us in this body, went down there 
and swore an oath to uphold. Those are the first words of this, Chris.
  And, God, I remember your agony.
  Folks, I want you to know, when I came to this body, my staff was 
talking about the maiden speech, the maiden speech.
  Please don't go back and look at my maiden speech--not great.
  But the maiden speech my staff wanted me to watch was yours, and it 
was gut-wrenching about Newtown, gut-wrenching that the strongest 
Nation on planet Earth should now be this Nation where we tell our 
children in this implicit lesson--not explicit but implicit lesson--
that we are going to teach you how to hide, we are going to run active 
shooter drills because we can't protect you.
  My mom lives in Vegas--that Vegas shooting. The shooting at a 
synagogue in Pittsburgh.
  So here we were in yet another of these maddening realities in our 
country that the leading cause of death for our children is shooting. 
In our conversations leading up to it, I still remember you and I 
saying: We need to come to this floor.
  You said: I am going to stand and do something different.
  And we--again, just like tonight--we had no end to that. We were 9 
years younger, my friend, and we said we were going to stand down here 
and try to get this body to do something different, try to get this 
body to recognize the gravity of what was going on in the strongest 
Nation on Earth that was having child after child after child, American 
after American dying of gun violence. And the response we were getting 
from this body--the world's most deliberative body--was nothing is 
going to change. We can't do anything.

  I mean, I am giving you respect years later. You were part of the 
first gun legislation to pass out of this body in 30-something years. 
And now I just found out that the Community Violence Intervention money 
that you allowed me to fight so hard to get in that bill is being 
clawed back by Donald Trump--our bipartisan bill, our bipartisan-
approved finances, money, and I think the taking away of our power in 
this body--from the bill that you were one of the main architects of 
with Republican colleagues, God bless them, people like Cornyn and 
others.
  I want to take people back to what the insider conversations--and you 
were generous. I want to remind you, teasingly, on the floor, you never 
asked me if you could publish my text messages, but you put them in 
your book.
  Mr. MURPHY. I did.
  Mr. BOOKER. It is a great book. I actually learned--I read my 
colleague's book, and I learned a lot of data about gun violence from 
your book.
  We were talking about this belief that these words--this belief in 
our country that these words, why this government was formed is so 
important. America, this is who we are, these imperfect geniuses. We 
formed this:

       We the people, in Order to form a more perfect Union, 
     establish Justice, insure domestic Tranquility, provide for 
     the common defense, promote the general Welfare, and secure 
     the Blessings of Liberty.

  You stood right down there for 15 hours. I paced this room pledging 
to you I wouldn't go to the bathroom. I wouldn't sit down. And I was 
hurting after 15 hours, but you were steadfast until we finally got 
Mitch McConnell to give us something. It was one or two votes. It was 
two votes. Both of them failed; we didn't get 60. At least what we 
forced this institution to do was to confront the horrendous horrors of 
that nightclub shooting.
  So you ask me now--as you and I and my dear brother whom I have known 
since he was coming out of college, three of us on this floor at a new 
day, it is past midnight, a new month, it is past midnight as we sit 
here--why? Because of your question. I can't stand anymore to live in a 
country where it seems that these convulsions come that threaten our 
most vulnerable over and over again. I can't stand it. I have to stand 
up and speak up. We have to do something different yet again. You and I 
talked about this last week.
  America, we are not doing a good job right now. We read the section 
about medical debt. Tens of millions of Americans are saddled with 
medical debt. Sixty-six percent of the people that declare bankruptcy 
is because they can't afford their medical bills because something that 
happened to them could happen to us and our families.
  My mother, my brother, and I had a lot of challenges, a lot of 
problems, but we weren't saddled with a rare disease. We didn't have 
tumors springing up all over our bodies. I don't know what that would 
have done to my family.
  Mr. MURPHY. Will the Senator yield?
  Mr. BOOKER. Yes.
  Mr. MURPHY. There is so much similarity between the debate that you 
are forcing this Senate to have tonight and the debate that we were 
having back in 2016 on this epidemic of gun violence. I would describe 
it this way. The only thing that matters, the thing that matters more 
than anything else in your life is protecting your loved ones from 
physical harm.
  Mr. BOOKER. Yes.
  Mr. MURPHY. You would give anything, right? Anything. You would give 
your life savings, your house. You would perhaps give your own life in 
order to protect your child or your brother or sister or mother or 
father from physical harm. So when you and I have sat across from the 
victims of gun violence, many of whom live in your neighborhood and my 
neighborhood, in Newark and Hartford, we are looking at a kind of 
desperation and sorrow that is unique--that is unique that also

[[Page S1959]]

comes with not just losing a loved one to gun violence but feeling 
powerless in that exercise.
  Mr. BOOKER. Yes.
  Mr. MURPHY. Feeling like there was nothing you could do and watching 
your elected leader stand by and allow for this reality to continue to 
occur in your neighborhood, where kids are being shot down in cold 
blood and your elected leaders--the adults in charge of your 
community--are standing idly by.
  That is not fundamentally different than the reality that will be 
visited upon millions of families if this size of a cut in Medicaid 
funding goes into effect because families out there who rely on 
Medicaid to keep alive their son or daughter who has a complicated 
medical disease have no other quarter, have no other last resort 
besides Medicaid. Medicaid stands between life and death for their son 
or daughter. There is no other place for them to go.
  So that same empty, hollow look that we have seen so many times in 
the eyes of a mother or father who lost a son or daughter to gun 
violence, that is the look that we are choosing to visit upon millions 
of families in this country who, when faced with the loss of their only 
health insurance option for their disabled child, will watch their 
child potentially face the same fate as those young men in your 
neighborhood and my neighborhood.
  That is the reason why I pose this question to you that you are 
answering about the moral gravity of this moment because it is not 
fundamentally different than the one that brought us here in 2016.
  Mr. BOOKER. In answering this question--again, I continue to yield 
the question to you while retaining the floor. I want to just compound 
this for people. I know these numbers--$880 billion, 100 million 
Americans affected that would be affected directly by Medicaid cuts or 
the people that work in the hospitals will be affected by Medicaid cuts 
or nursing homes affected by Medicaid cuts--these are big, big numbers. 
But people, these are human beings.

  I was in a community that had a horrible lead poisoning problem for 
their kids, that had horrible toxic sites. And children born around 
toxic Superfund sites, as you know they are called, have higher rates 
of autism, higher rates of birth defects.
  Even coming up as a city council person, I saw that the environmental 
injustices surrounding my community were causing parents to have to 
deal with medical complications amongst their children at alarming 
rates and needed help, and Medicaid was the program--no fault of their 
own, environmental injustice.
  Here is the double insult of the Trump administration. One is they 
gutted the Environmental Justice section at the DOJ. They are not 
investigating corporate polluters. They are not investigating the 
injustices environmentally that big, powerful, wealthy people do that 
often cause people--we all saw ``Erin Brockovich''--that cause people 
to get seriously hurt.
  And then the second part of that insult is, we are not only not going 
to hold people accountable and let them get away with that, the 
polluters, the folks causing the source of the disease, we are now not 
going to get healthcare to the families who often live in fragile 
communities that have these resources.
  These are the people, when you sit with them in your offices, as you 
and I have and the other Senator from New Jersey on the floor tonight 
has--as you sit with them and they tell you their stories and you see 
that this is a lifeline, this Medicaid Program--and you are so good by 
telling people--I saw this during the Affordable Care Act. Just the 
name alone, people were like, I don't have ObamaCare. Yes, you have the 
ACA, and let me explain it to you. It is under many, many different 
names, including in my State that people don't know this is a Medicaid-
funded program. So they don't know this is a sort of Damocles of their 
family's well-being. But this is the larger issue, Senator Murphy, is 
these are real people in every county, in every State.
  It is why their representatives--it is why I read statements 
demanding there not to be cuts by the organizations that are 
bipartisan. I read the League of Cities--the largest mayoral 
association--Republican Governors, and others are all saying do not cut 
this program. They are not even saying, ``Don't do $880 million, just 
do $400 million.'' They are saying, ``Do not cut this program.''
  Many are saying we need to find ways to expand the program because 
there are still gaps that people are falling into. And it doesn't make 
economic sense because if you get regular care, if your chronic disease 
is treated, it ultimately could be cheaper to the taxpayer as opposed 
to people ending up in hospitals. But those hospitals now, because of 
what is being threatened in this bill, rural hospitals and tier I 
trauma hospitals, are all being threatened in their care.
  So tonight, it is not normal. I ask everybody to understand this is 
not a normal moment in America. This is a crossroads moment in America. 
It is one of those times where the values that we talk about in the 
Constitution are at stake. What is going to define us, our commitments 
to ideals of justice, fairness, of being there for each other.



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