[Congressional Record Volume 171, Number 109 (Wednesday, June 25, 2025)]
[Senate]
[Pages S3540-S3543]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
ONE BIG BEAUTIFUL BILL
Mr. SANDERS. Mr. President, the so-called reconciliation bill or Mr.
Trump's Big Beautiful Bill that the Republican leadership is now
attempting to rush through the Senate is a rather extraordinary piece
of legislation. In many respects, given the crises facing our country,
this legislation does exactly the opposite of what should be done.
Whether you are a Democrat, a Republican, or an Independent, you
know--no one has any doubt about it--that our current healthcare system
is broken. It is dysfunctional. It is a cruel system, and it is wildly
expensive. We spend over $14,500 per person on healthcare, double what
most countries around the world pay per person.
And despite all of that spending, some 85 million Americans today are
uninsured or underinsured. And we remain the only major country on
Earth not to guarantee healthcare to all people as a human right. And
one out of four people who go into a pharmacy to get their prescription
drugs can't afford that medicine because of the outrageously high
prices.
So now, given that reality, how does this reconciliation bill address
the horrific healthcare crisis that our country is experiencing?
What one might think is that given 85 million people being uninsured
or underinsured, this bill would lower that number. It would provide
healthcare to more Americans. Given the fact that we are spending twice
as much per capita on healthcare as any other nation, one might think
that this legislation would lower the cost of healthcare. Given the
fact that the insurance companies and the drug companies rip us off
every day and make huge profits out of the system, one might think that
this legislation would take on the greed of the pharmaceutical industry
and the insurance companies.
Well, if that is what you think rational legislation should do,
understand that this bill does none of that--in fact, does exactly the
opposite.
This legislation, if enacted, would make the largest cut to
healthcare in our Nation's history in order to pay for the largest tax
breaks for the rich that we have ever, ever seen--massive cuts to
healthcare in order to provide tax breaks for billionaires.
The Congressional Budget Office has estimated that this legislation
would cut Medicaid and the Affordable Care Act by over $1 trillion.
Those cuts, along with ending the enhanced premium credits for the ACA,
will lead to 16 million people losing their health insurance.
That is not what Bernie Sanders has said; that is what the director
of the Congressional Budget Office has told us. That is the nonpartisan
group that works with Congress.
Mr. President, this bill, further, for the first time, forces
millions of Medicaid recipients who make as little as $16,000 a year to
pay a $35 copayment every time they visit a doctor. So 16 million
people are thrown off of healthcare. Low-income, working-class people
are now forced to pay a $35 copayment.
What is the impact of all of that? Well, it will not surprise
anybody, if people don't have access to healthcare, if they can't get
to a doctor when they are sick, people will suffer, and tens of
thousands of them will die.
The Yale University School of Public Health and the University of
Pennsylvania estimated in a recent study that if the reconciliation
bill is enacted, over 50,000 Americans will die unnecessarily every
year. That is what we are talking about--50,000 Americans dying
unnecessarily because they are thrown off of healthcare; they can't
afford to see a doctor each and every year.
What is the reason for that? What is the motivation for that horrific
action? It is to give massive tax breaks to the very wealthiest people
in this country, people who do not need them. Not only would millions
of Americans lose their health insurance and tens of thousands of our
constituents needlessly die if this legislation is enacted, rural
hospitals all over this country--rural hospitals that are already
struggling--would be forced to shut down, lay off workers, or
substantially reduce the services they provide. In other words, at a
time when rural America is struggling--and I come from one of the most
rural States in America, that is what Vermont is--this bill would be a
disaster for rural America.
Further, when Trump and the Republicans in Congress make massive cuts
to Medicaid, they are not just attacking individuals, they are also
going after and negatively impacting community health centers, which
provide primary healthcare to 32 million lower income and working-class
Americans in every State in this country. Community health centers rely
on Medicaid for 43 percent of their revenue. And when you cut hundreds
of billions of dollars in Medicaid, you are significantly cutting back
on the access that millions of Americans will have to the primary
healthcare they desperately need.
At a time when the healthcare system in America is broken, when
primary healthcare is even in worse shape, this will make access to
primary healthcare even more difficult.
Some 22 percent of our seniors in this, the richest country on Earth,
are trying to survive on less than $15,000 a year. This legislation
will make it harder for seniors and people with disabilities to receive
the care they desperately need in nursing homes. Nursing homes in
Vermont--and I expect in every State in this country--are struggling.
They are understaffed. Workers there are underpaid. The quality, in
many cases, is not as good as it should be. But when Medicaid now
provides 60 percent of the revenue nursing homes rely on, slashing
Medicaid will make a disastrous situation even worse for some of the
most vulnerable people in our country.
Let us be clear. Let us not run away from it. Let us not double-talk
this issue and come up with all kinds of absurd rationalizations. This
legislation coming before the Senate this week is the most significant
attack on the
[[Page S3541]]
healthcare needs of the American people in the modern history of our
country.
And once again--once again--we are throwing millions of people off
the healthcare that they depend upon to stay alive in order to give tax
breaks to billionaires who have more wealth today than they will need
for a hundred lifetimes. And yet, oddly enough, despite the enormity of
what this legislation is about, not a single committee in the Senate
has held a single hearing on the impact this legislation will have. In
my view, really, this is absolutely irresponsible.
I am not quite sure why we continue to even have committees if the
Health and Labor Committee, of which I am ranking member, does not hold
a hearing on the most important piece of health legislation in the
modern history of this country. That is why this morning, I released,
as leader of the minority on the committee, a report discussing the
impact that this legislation would have on our Nation's healthcare
system. I did that by doing something pretty radical, I guess. We
actually reached out to healthcare providers all over the country.
If you are going to decimate American healthcare, you may want to
talk to the doctors and the nurses and the healthcare organizations
around America. I think that is kind of a commonsense thing to do.
Let me take this opportunity to thank the over 750 healthcare
providers from 47 States who responded to my request. I want to thank
them sincerely for their thoughtful responses. We basically said: What
is this legislation going to do in your State? And we got hundreds and
hundreds and hundreds of responses.
Mr. President, I ask unanimous consent that this report be printed in
the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
Health, Education, Labor and Pensions Committee
IN THEIR OWN WORDS: WHAT DOCTORS, NURSES, HOSPITALS, AND OTHER
PROVIDERS THINK ABOUT REPUBLICAN CUTS TO HEALTH CARE
I. Executive Summary
The Senate is rushing to pass the largest cuts to federal
health care programs in the history of Medicaid and the
Affordable Care Act (ACA). The Republican budget bill, which
passed the House by only a single vote, would slash federal
health care programs by over $1 trillion. These cuts, along
with the elimination of tax credits for ACA coverage, will
take health care away from 16 million people. In some states,
such as Florida, Louisiana, Massachusetts, and Washington,
the Republican budget bill will nearly double the number of
people without insurance.
Remarkably, despite the major changes the Republican budget
bill would make to our health care system, the Senate is
moving towards passing the bill without a single hearing or
vote in Committee. No doctor, nurse, hospital, community
health center, or nursing home has been formally consulted to
help explain to the American people what these proposed
changes would actually mean.
This month, Senator Bernie Sanders (I-Vt.), Ranking Member
of the Senate Committee on Health, Education, Labor, and
Pensions (HELP), asked health care providers across the
country what this bill would mean for their patients. Over
750 health care providers from 47 states and the District of
Columbia shared their serious concerns.
HELP Minority Staff reviewed these submissions from health
care providers, as well as health policy research and other
publicly available information, to document how the
Republican budget bill would turn the crisis in American
health care into a national emergency.
Health care providers expressed deep concerns that the bill
would lead to more patients getting sick and dying; higher
health care costs as patients delayed preventative care and
visited more emergency rooms; and more hours spent on
paperwork. Taken together, higher costs and lower
reimbursement would cause providers to cut health services,
lay off clinical staff, and close facilities entirely. This
would impact everyone--not just those receiving health
coverage through Medicaid and ACA.
TABLE 1--HEALTH CARE PROVIDERS RAISE SERIOUS CONCERNS ABOUT REPUBLICAN
HEALTH CARE CUTS
------------------------------------------------------------------------
Concern Provider Response
------------------------------------------------------------------------
More patients will get sick and die.... ``If Medicaid is cut, my
patients will die. I realize I
am being dramatic. It is a
dramatic situation.'' Dr.
Helen Pope, Louisiana.
``[T]hey are humans who are
doing their best. Please don't
allow them to suffer more.''
``Patients will fall through
the cracks, not because
they're unwilling to care for
themselves, but because we've
made the system too
complicated, too conditional,
and too punitive. In rural
communities like mine, people
already struggle with trust,
stigma, and access. This bill
risks making all three
worse.'' Bradley, Medical
Student, Kentucky.
``Plainly said, children will
die as a result of these cuts.
Hospitals will cut back on ICU
doctors, doctors will leave
because of salary cuts,
critical ancillary services
will be reduced, more medical
students will avoid going into
pediatric residencies.'' Dr.
Farhan Malik, Florida.
``The proposed cuts to Medicaid
will cause untold hardship and
deaths among my patients.
DON'T DO THIS! You don't want
the deaths of tens of
thousands of Americans on your
hands.'' Dr. Sanjay Chaube,
Louisiana.
Costs will increase as sick patients ``Outcomes are worse when care
delay care and visit emergency rooms. is less accessible. Few
doctors, hospitals, clinics
mean more visits to the
emergency room with worse
presentation and ultimately is
more expensive.'' Dr. Bonnie
Sand, Maine.
``The provisions would
ultimately make healthcare
more expensive and less
accessible while paradoxically
making Medicaid unsustainable.
When patients lose access to
preventive care, they rely on
emergency services and
dangerous self-treatment, both
driving up costs for everyone.
Medicaid allows us to treat
and prevent disabling
conditions like diabetes and
hypertension--without it,
these become irreversible.''
Dr. Nikhil Kurapati, Ohio.
``If the proposed bill is
passed and [my patients']
Medicaid insurance is cut, it
doesn't mean their asthma will
go away. It will mean that in
most cases they will not
receive preventative care, and
as a result, their asthma will
worsen. . . . Worse yet, they
would be seen in the emergency
room more often and admitted
to the hospital. This care is
more expensive, and less
effective, than preventative
care, and some children will
die of their asthma.'' Dr.
Gregory Omlor, Akron
Children's Hospital, Ohio.
Providers will need to spend hours more ``Our care managers and front-
to handle extra paperwork, including desk staff would likely spend
by hiring more staff. an additional 10-15 hours per
week assisting patients with
insurance-related forms . . .
In small clinics, that's the
equivalent of losing nearly
half a staff member's
availability for patient
support.'' Trent Bourland,
Regional VP of Rural Health,
SSM Health Oklahoma.
``These changes would
dramatically increase the
administrative burden on our
care team. We would likely
need to hire at least 1-2 full-
time administrative staff just
to track patient eligibility,
navigate complex documentation
requirements, and assist
families with enrollment or
appeals. This would divert
already limited funding away
from clinical care and impose
new costs on our department.''
Ashley, Social Worker, South
Carolina.
Facing higher costs and lower ``These harmful proposals will
reimbursement, providers will be impact access to all patients
forced to cut health services, layoff who are served by our nation's
staff, and even close facilities hospitals and health systems.
entirely. These cuts will strain
emergency departments as they
become the family doctor to
millions of newly uninsured
people. Finally, the providers
will force hospitals to
reconsider services or
potentially close,
particularly in rural areas.''
Rick Pollack, President and
CEO, American Hospital
Association.
``Louisiana's rural hospitals
and healthcare providers are
already operating on razor-
thin margins, struggling to
keep their doors open while
serving some of our most
medically vulnerable
communities. In Louisiana, 38%
of hospitals operate on
negative margins and 27% are
currently vulnerable to
closure. Medicaid cuts would
worsen these losses, putting
more hospitals at risk of
shutting down entirely.''
Louisiana Rural Health
Association.
``If our patients lose Medicaid
coverage, they will still need
our care and our hospital will
provide it. But this will mean
more uncompensated care and
even worse bottom lines. The
city will need to pull funding
from elsewhere to help the
hospital keep running as is,
or we will be forced to cut
staffing or services in order
to stay open.'' Dr. Katrina
Marie Green, Tennessee.
``These cuts will cause rural
hospitals in Texas to close
entirely. As a neurologist, I
am terrified that the closest
hospital for many rural folks
may then be hours away. During
an ischemic stroke, there is
only 3 hours of precious time
. . . the increased travel
time may cause unnecessary
cases of paralysis and
death.'' Dr. Audrey Nath,
Texas.
``The proposed cuts would
require our organization to
cut back on the number of
clinical staff that serve our
residents. It would also cause
[us] to stop our plan to
improve the physical plant
improvements for our skilled
nursing center that are
designed to bring greater
dignity, safety, and clinical
effectiveness to our
residents.'' President & CEO
of a provider organization,
Kentucky.
``Our margin last year was -
31%, burning through cash to
see patients, the majority of
whom are on Medicare or
Medicaid. If they lose
Medicaid, we'll still take
care of them because that's
what we do, but the bills
won't get paid.'' Tom
Reinhardt, CEO, Cascade
Medical Center, Cascade,
Idaho.
``With significant cuts to
Medicaid (and any cuts to HRSA
or other grant funding for
FQHCs), we may not be able to
keep the doors open. We would
potentially have to stop
caring for many of our
patients.'' Dr. Mia Henderson,
Missouri.
------------------------------------------------------------------------
The responses included in the report represent a mere
fraction of the responses reviewed by HELP Minority Staff
raising concerns about the Republican health care cuts. Taken
together, doctors, nurses, hospitals, and providers are clear
about the immense harm the Republican health care cuts pose
to their patients. The consequences also extend well beyond
Medicaid and the Affordable Care Act. As one California
doctor described it, ``If Medicaid collapses, the entire
health care system collapses.''
The American people should not be forced to lose their
health insurance--or pay higher premiums, higher copays, and
higher costs at the pharmacy counter--so that Republicans can
pay for tax breaks for the wealthy. Consider, for example,
that the one trillion-dollar cuts to health care in the bill
are nearly equivalent to the $1.1 trillion in tax breaks that
households above $500,000 will receive from the legislation.
Or that the bill provides tax breaks to more than 800,000
millionaire households, while ripping health insurance away
from 16 million people--a ratio of over 19 to 1.
When all the spending and tax cuts are put together, the
Penn Wharton Budget Model finds that the 40 percent of
Americans making $51,000 or less would see their taxes go up
in 2026 by hundreds of dollars, while those making at least
$4.3 million would see a tax cut of $390,000.
As one doctor from Maine notes: ``We have an existential
choice to make. The very wealthy want to steal from the less
wealthy
[[Page S3542]]
and poor Americans. We cannot allow that to happen. This
legislation must not pass.
Appendix
HELP Minority Staff used KFF data to estimate the increase
in the uninsured rate from 2023 to 2034 as a result of the
One Big Beautiful Bill Act. A 100 percent increase means the
number of uninsured doubled.
REPUBLICAN BILL WILL LEAD TO A MASSIVE INCREASE IN AMERICANS LOSING HEALTH INSURANCE
----------------------------------------------------------------------------------------------------------------
2023 Uninsured 2034 Uninsured Percent
State Rate Rate Increase
----------------------------------------------------------------------------------------------------------------
Alabama......................................................... 8.2% 11.6% 46%
Alaska.......................................................... 10.0% 13.3% 35%
Arizona......................................................... 9.6% 13.4% 50%
Arkansas........................................................ 8.9% 13.1% 48%
California...................................................... 6.2% 10.2% 74%
Colorado........................................................ 6.5% 8.6% 50%
Connecticut..................................................... 5.4% 9.6% 77%
Delaware........................................................ 6.6% 10.0% 60%
District of Columbia............................................ 2.6% 7.3% 229%
Florida......................................................... 10.4% 18.8% 98%
Georgia......................................................... 11.1% 16.7% 61%
Hawaii.......................................................... 2.7% 4.9% 99%
Idaho........................................................... 8.8% 10.2% 28%
Illinois........................................................ 6.0% 10.4% 74%
Indiana......................................................... 6.6% 10.0% 55%
Iowa............................................................ 4.9% 7.6% 61%
Kansas.......................................................... 8.1% 10.5% 32%
Kentucky........................................................ 5.5% 9.7% 81%
Louisiana....................................................... 6.7% 12.4% 91%
Maine........................................................... 5.9% 8.8% 49%
Maryland........................................................ 6.2% 8.7% 50%
Massachusetts................................................... 2.5% 5.6% 135%
Michigan........................................................ 4.3% 7.6% 78%
Minnesota....................................................... 3.9% 6.8% 84%
Mississippi..................................................... 10.1% 15.7% 54%
Misouri......................................................... 7.3% 10.6% 47%
Montana......................................................... 8.3% 11.7% 48%
Nebraska........................................................ 6.2% 8.4% 44%
Nevada.......................................................... 10.5% 11.9% 27%
New Hampshire................................................... 4.4% 6.4% 47%
New Jersey...................................................... 7.0% 10.9% 63%
New Mexico...................................................... 8.7% 13.0% 51%
New York........................................................ 4.7% 8.8% 100%
North Carolina.................................................. 8.9% 13.0% 54%
North Dakota.................................................... 4.0% 6.0% 73%
Ohio............................................................ 5.9% 9.5% 63%
Oklahoma........................................................ 11.0% 14.8% 38%
Oregon.......................................................... 5.3% 9.5% 97%
Pennsylvania.................................................... 5.2% 8.2% 59%
Rhode Island.................................................... 4.3% 8.2% 98%
South Carolina.................................................. 8.7% 13.1% 58%
South Dakota.................................................... 8.3% 10.0% 26%
Tennessee....................................................... 9.0% 12.5% 45%
Texas........................................................... 16.0% 20.0% 39%
Utah............................................................ 7.6% 11.3% 69%
Vermont......................................................... 3.3% 6.0% 85%
Virginia........................................................ 6.2% 9.0% 56%
Washington...................................................... 6.2% 11.0% 102%
West Virginia................................................... 5.8% 10.0% 68%
Wisconsin....................................................... 4.8% 6.3% 34%
Wyoming......................................................... 10.2% 12.2% 20%
----------------------------------------------------------------------------------------------------------------
Mr. SANDERS. Mr. President, let me just summarize and quote a small
number of the responses that we got. If this legislation were to be
signed into law, it would drive up the number of uninsured Americans in
every single State in this country.
For example, if this legislation was signed into law, the uninsured
rate in my State of Vermont would go from 3.3 percent to 6 percent. In
Louisiana, the uninsured rate would go from 6.7 percent to 12.4
percent. In the State of Washington, the uninsured rate would go up
from 6.2 to 11 percent. In Florida, the uninsured rate would go up from
10.4 percent to 18.8 percent, almost 19 percent of people in Florida
will be uninsured if this bill goes through. And this is true for every
State in the country--in many cases, almost doubling the number of
uninsured.
Let me just quote for you what healthcare providers and State
organizations around the country are saying as to the horrific impact
that this legislation would have. I know many of my Republican
colleagues get up and say it is not true; it is this, that, and the
other thing. Listen to the doctors, listen to the organizations, the
healthcare providers in your own State.
Let me just begin with Texas, a Dr. Audrey Nath, where the uninsured
rate will reach 20 percent. Anybody from Texas watching this, you are
going to be--if this bill goes through, you might want to say hello to
your Senators here. Your uninsured rate is going to go up to 20
percent.
This is what Dr. Audrey Nath wrote:
These cuts will cause rural hospitals in Texas to close
entirely. As a neurologist, I am terrified that the closest
hospital for many rural folks may then be hours away. During
an ischemic stroke, there is only 3 hours of precious time--
If you have a stroke, you have to get care very quickly. She writes
that ``the ``increased travel time may cause unnecessary cases of
paralysis and death.''
That is obviously what happens, not only with a stroke but for many
other illnesses if you don't have a hospital nearby.
Dr. Farhan Malik from Florida, where the uninsured rate will surge to
almost 19 percent, wrote:
Plainly said, children will die as a result of these cuts.
Hospitals will cut back on ICU doctors, doctors will leave
because of salary cuts, critical ancillary services will be
reduced and more medical students will avoid going into
pediatric residencies.
Dr. Mia Henderson, who works at a community health center in
Missouri, wrote that the cuts to Medicaid contained in this legislation
would mean that ``we may not be able to keep the doors open''--of the
community health center. ``We would potentially have to stop caring for
many of our patients.''
The Louisiana Rural Health Association wrote:
Louisiana's rural hospitals and healthcare providers are
already operating on razor-thin margins, struggling to keep
their doors open while serving some of our most medically
vulnerable communities. In Louisiana, 38 percent of hospitals
operate on negative margins and 27 percent are currently
vulnerable to closure. Medicaid cuts would worsen these
losses, putting more hospitals at risk of shutting down
entirely.
Dr. Sanjay Chaube, a doctor from Louisiana, told the HELP Committee:
The proposed cuts to Medicaid will cause untold hardship
and deaths among my patients. DON'T DO THIS!
He puts that in capital letters.
You don't want the deaths of tens of thousands of Americans
on your hands.
That is Dr. Chaube from Louisiana.
Dr. Gregory Omlor from Akron's Children's Hospital in Ohio told us:
If the proposed bill is passed and [my patients'] Medicaid
insurance is cut, it doesn't mean their asthma will go away.
It will mean that in most cases they will not receive
preventive care . . . [and][s]ome children will die of their
asthma.
And here is what another doctor from Ohio said:
Implementing work requirements into Ohio Medicaid will
threaten my patients' gains. Most of my patients WANT to
work--they are desperate to. There just aren't jobs available
for folks with very low skills and health conditions that
could cause them to miss work unexpectedly. The jobs that are
available do not pay enough for an adult to survive, and they
certainly don't offer health insurance. My patients who rely
on Medicaid have frequently been born into generational
poverty, have only had access to poor quality schools, and
live in neighborhoods where their health suffers.
And by the way, this Dr. Omlor talks about work requirements. Let us
understand that every single year millions and millions and millions of
Americans lose their jobs not through any fault of their own. The
company shuts down, company goes bankrupt, whatever it may be, they
lose their jobs. They don't have a job. How are they going to get
healthcare? We have taken healthcare away from them because they are
not working.
The Vermont Association of Hospitals--my own State--the Association
of Hospitals and Health Systems wrote that this bill ``reduces coverage
and access, particularly in rural areas such as Vermont where hospitals
and other health care providers are already financially fragile'' and
that it will force hospitals in Vermont to ``cut back on clinical
staff, services and care delivery.'' I can tell you hospitals in
Vermont are struggling. This will make a very, very difficult situation
even worse.
Now, I have got a radical idea, probably one that, I would say, 70 or
80 percent of the American people agree with, and that is maybe, just
maybe, instead of throwing 16 million people off of healthcare, instead
of creating a situation where 50,000 Americans die unnecessarily, why
don't we do what every other major country on Earth does and guarantee
healthcare to all people as a human right.
What about that?
Instead of throwing 16 million people off so we have almost 100
million uninsured, hey, why don't we do what Canada does, what the UK
does, what Spain does, what Finland does, what Holland does, what every
other major country on Earth does--guarantee healthcare to all people
as a human right.
But the problem there is it is easier to throw working people off of
their health insurance around here than to take on the Big Money
interests who run the insurance industry and the pharmaceutical
industry. That is what this is about.
In many respects, this bill represents exactly why many Americans are
giving up on democracy and have such contempt for Congress and for the
Democratic Party and for the Republican Party. At a time when the
richest people have never ever had it so good, they now see Republican
leadership working overtime to make the billionaire class even
wealthier. At a time when the majority of Americans are struggling to
put food on the table and pay for healthcare, they see Republican
leadership making life even more difficult for average Americans.
[[Page S3543]]
So I would say that I speak for the overwhelming majority of the
American people who think that it is basically insane that we are
talking about throwing 16 million people off of the healthcare they
have and creating a situation where 50,000 Americans will die
unnecessarily each year in order to give hundreds and hundreds and
hundreds of billions of dollars to billionaires and the wealthiest
people in this country. This is a disastrous, obscene piece of
legislation. It must be defeated.
____________________