[Congressional Record (Bound Edition), Volume 163 (2017), Part 1]
[Senate]
[Pages 441-459]
[From the U.S. Government Publishing Office, www.gpo.gov]




    CONCURRENT RESOLUTION ON THE BUDGET, FISCAL YEAR 2017--Continued

  Mr. DAINES. Mr. President, I ask unanimous consent that the Senate 
resume consideration of S. Con. Res. 3.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.


                         Order For Adjournment

  Mr. DAINES. Mr. President, if there is no further business to come 
before the Senate, I ask unanimous consent that it stand adjourned 
under the previous order, following the remarks from my Democratic 
colleagues.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator from Massachusetts.
  Mr. MARKEY. Thank you, Mr. President.
  I just want to follow up on the statements made by the Senator from 
Connecticut, Mr. Blumenthal, and the Senator from Hawaii, Mr. Schatz. 
They have laid out in eye-watering detail the problems that the 
Republicans are creating by their attempt to repeal the Affordable Care 
Act. What Senator Schatz and Senator Blumenthal did was just get to the 
heart of this matter.
  What the United States did for 100 years was to not run a health care 
system but to run a sick care system--a system that spent 97 cents on 
what happens after people got sick and only 3 cents of every dollar on 
trying to prevent people from getting sick. For the first time in 
American history, that changed in the Affordable Care Act.
  What President Obama did, what America did was to create a Prevention 
and Public Health Fund, and that fund in the Affordable Care Act is 
spent on prevention programs. It is spent on looking at people who 
could get asthma, diabetes, heart disease, obesity, high blood 
pressure, stroke, or die from too much smoking and just say for the 
first time, in a comprehensive way, that the United States was going to 
put programs in place that would prevent people from getting the 
diseases that every preceding generation of Americans have suffered 
from. That is what the prevention fund is all about. That is what the 
Republicans are going to repeal, take off the books--this fundamental 
change to the direction toward prevention, toward wellness that all 
Americans of all generations want to see remain on the books.
  In Massachusetts, if you are in New Bedford or Fall River or if you 
are in Springfield, those programs target racial minorities, they 
target low-income families, they target seniors who would otherwise be 
vulnerable to diseases that these programs can help to prevent. That 
money is just going to be sliced out of the Federal budget. What will 
be the consequences? Well, quite clearly, it will cost America a lot 
more money.
  For example, my father died from lung cancer, smoking two packs of 
Camels a day. How many other fathers, mothers, sisters, and brothers 
die from a totally preventable disease? Well, ladies and gentlemen, 
this prevention fund put into place the kind of funding on a consistent 
basis not just for antismoking programs but for all programs across the 
books.
  I will give you a good example. Back in the 1930s, no women, for the 
most part, died from lung cancer in the United States. But in the 1950s 
and 1960s, the tobacco industry hired the smartest PR person in 
America. This campaign basically said: ``You've come a long way, 
baby.'' You have an equal right to get cancer, as your husband, 
boyfriend, father, or brother has, and 20 years later, unbelievably, 
women began to die in the United States from lung cancer at a rate that 
was higher than the number of women who were dying from breast cancer.
  Now that is a public relations success of the first and highest 
magnitude. We didn't have prevention programs in place. We didn't have 
a warning system to say to women, to say to kids: This is dangerous to 
your health. What did we see? We saw just about every family in America 
with somebody who died from lung cancer--pretty much every family--and 
it was totally preventable.
  Well, inside of the Affordable Care Act we have this huge, great, 
innovative breakthrough--a health and prevention program that could be 
used in every city, every town, and every State across the whole 
country, targeting the most vulnerable, the most likely to be targeted, 
the ones most likely to be engaging in dangerous behaviors that are 
otherwise preventable. We have cured most of the diseases that our 
grandparents died from. The diseases that people die from today are the 
diseases that they give to themselves. They are behavioral choices. 
They are environmental situations into which they are placed that then 
result in them, unfortunately, contracting the chronic diseases that 
wind up first harming them and ultimately killing them.
  What is a good example? Well, a good example is opioids. Opioids are 
now a killer of a magnitude that is almost incomprehensible. In 
Massachusetts, 2,000 people died in 2016 from opioid overdoses. Now, we 
are only 2 percent of the population of the United States of America. 
If you multiply that by 50, it is 100,000 people dying from opioid 
overdoses if they die at the same rate as the people who are dying in 
Massachusetts--100,000 a year, two Vietnam wars of deaths every single 
year from opioid overdoses. If ever there was a preventable disease, if 
ever there was something that was completely and totally subject to 
having programs put in place that could help people avoid ever getting 
into that addiction situation--or, once they did, giving them the 
program money which they need--then opioid addiction is it.
  Well, what the Republicans are doing here is just wiping it out. They 
are wiping out that prevention fund. Moreover, just for the sake of 
understanding how incredible everything they are considering is going 
to be in terms of prevention of opioid disease, Medicaid right now pays 
$1 out of every $5 for substance use disorder treatment in the United 
States of America. In other words, without these prevention funds, 
without Medicaid funding, the only choice for these families is either 
getting help or getting buried. That is the bottom line. What the 
Republicans are doing is just wiping out the help.
  So the option is going to be not just 2,000 in Massachusetts 
multiplied by 50,000, 100,000 deaths a year, we are just

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going to see this number skyrocket because without public health, 
without prevention programs, this is an inexorability, it is an 
inevitability. This is the future. This is just a repetition of 
everything America did for the preceding 100 years before we put the 
Affordable Care Act on the books. It doesn't make any difference 
whether you come from Connecticut or Hawaii, from Virginia or Michigan, 
from Massachusetts or from any other State in the Union, there are no 
barriers to opioid overdose, tobacco deaths, obesity, all of these 
preventable diseases. It is all coming as a preview of coming 
attractions to families all across the country. Here it is. This is 
what the Republicans are promising you: your family, once again, 
exposed.
  Listen to this number. When the Affordable Care Act gets repealed by 
the Republicans, if they are successful--listen to this number: 1.6 
million people who right now are covered for substance use disorders 
will no longer have coverage. Let me say that again: 1.6 million people 
who have coverage for substance use disorders will no longer be 
covered. So we have the prevention fund over here, we have the 
insurance over here--both gone.
  I say to my colleagues, these Republicans--it is almost unbelievable. 
If you kick them in the heart, you are going to break their toe. We are 
talking about the most vulnerable people in our country. We are looking 
at the children. We are looking at people who have substance abuse 
disorders. We are looking at people who otherwise would never have 
smoked a day in their life if prevention programs were in place. We are 
looking at people who would never have to suffer through a life of 
obesity because the programs were put in place.
  What are they saying? They are saying we are going to substitute and 
create a new program. When? Maybe soon. Maybe just around the corner. 
Maybe next year. Maybe whenever we get to it. What do you say to those 
families? What do we say to them?
  This isn't just health care; this is also hope. This is also hope for 
these families who have chronic diseases, these families who have 
diseases that were otherwise preventable.
  What the Republicans are saying is, we are just going to pull a bait 
and switch on you. We are going to repeal right now and replace at some 
point of our choosing in the future, even though we have harbored an 
ancient animosity toward the creation of a national law in the first 
place, and the American people are supposed to gullibly accept that 
argument. Well, we know what they have always wanted to do: leave all 
of these health care programs, from Medicare to Medicaid, to Social 
Security, as death-soaked relics of the programs as they have been 
created by Franklin Delano Roosevelt, by Lyndon Johnson, by Bill 
Clinton, by Barack Obama. They have always harbored that animosity 
toward those programs. This is just the beginning of an assault upon 
generations of promises to American families who have been transformed 
by these programs.
  Let us fight hard, I say to my colleagues, to make sure these 
prevention funds are not taken off the books. It is the transformative 
way of looking at health care which the Affordable Care Act introduced 
into our society. I thank my friend Senator Blumenthal for leading us 
on this charge and Senator Schatz.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Virginia.
  Mr. KAINE. Mr. President, I rise with my colleagues, and I am 
thrilled to be here with them, to save our health care and to try to 
convince our colleagues that a repeal of the Affordable Care Act would 
be health care malpractice, and because health care is one-sixth of the 
American economy, it would be economic malpractice as well.
  What I thought I would do basically is just tell two stories. I am 
going to tell a Virginia story from before the passage of the 
Affordable Care Act, and I am going to tell a Virginia story since the 
passage of the act.
  I was first elected to statewide office in 2001, and I became the 
Lieutenant Governor of Virginia. Shortly after, I started to attend, on 
a fairly regular basis, a most amazing annual event. It is called the 
Remote Area Medical clinic in Wise County, VA. It is in the heart of 
Appalachia, in a community on the border of Kentucky where my wife's 
family is from. This was an annual medical clinic that was set up by 
some Catholic nuns who were driving a van around trying to offer 
medical care to people who didn't have it, and they decided they would 
recruit volunteers. They would set up at a dusty county fairground, the 
Virginia-Kentucky fairground in Wise, VA, and open the doors on 
Saturday to people who didn't have health care. It had been going for 
many years when I first went as Lieutenant Governor. I had heard so 
much about it, and I was anxious to go see it.
  Here is what I saw when I first went there. People start to come on 
about Tuesday of the week when it is going to open on Friday, and they 
come in groups of three or four families, and then they come in groups 
of ten or dozens, and then hundreds, and then thousands, to this dusty 
county fairground in late July--hot in Southwestern Virginia. They 
gather so that on Friday morning, at about 7 o'clock when it opens, 
they have gotten a number, they know where they are in the line, and 
sometime over the course of Friday and Saturday, they will be able to 
see a doctor, in some instances for the first time in their lives. 
There are doctors, dentists, medical students, the Lions Club 
volunteers to give vision screenings, hundreds of volunteers, and 
thousands of people seeking medical care.
  The first year I went to this, I was overwhelmed at the magnitude of 
the philanthropic spirit of the volunteers, and I was also overwhelmed 
at the depth of the need. Something made it more palpable by walking 
around the parking lot to see where people had come from.
  This is a community that is on the border of Virginia and Kentucky so 
I wasn't surprised to see Virginia license plates and Kentucky license 
plates. It is kind of near West Virginia so I wasn't surprised to see 
West Virginia license plates. It is near Tennessee. I saw Tennessee 
license plates. I saw North Carolina license plates. What struck me as 
I went through the parking lot was to see license plates from Georgia 
and license plates from Alabama and license plates from as far away as 
Oklahoma.
  We are the richest Nation on Earth. We are the most compassionate 
Nation on Earth. Yet, in order to get medical care, people would get in 
their cars and drive for days, and then camp for days, for the chance 
to see a doctor or a dentist.
  It reminded me that first year, and it reminds me still, of the way 
health care was delivered in the poor country of Honduras where I 
served as a missionary in 1980 and 1981. There wasn't really a health 
care network. Occasionally, missionaries or others would set up a 
clinic in a mountain community once a year--maybe less than that--and 
people would gather, and that was the way we were delivering health 
care in a successful State, in the most compassionate and wealthiest 
Nation on Earth. It is just not right. It is just not right.
  The RAM clinic still goes on. It hasn't gone away, but I will tell my 
colleagues what has happened since the passage of the Affordable Care 
Act. The percentage of Americans without health insurance has dropped 
from over 16 percent to about 8 percent. It has almost been cut in 
half, and the uninsurance rate in this country is at its nearly lowest 
percentage since we have been able to record that number. That means 
there is less of a need for the RAM clinics because more people can 
have a medical home and can seek care. That decline has also been 
significant because in Virginia, we were about 14 percent uninsured in 
2010, and that number has now come down to about 9 percent.
  So that first story--the story of this RAM clinic, pre-Affordable 
Care Act, with one in six Americans not having health insurance--we 
have done a good thing as a Congress to provide access to dramatically 
reduce that number.
  Let me tell my colleagues a second story. The second story is just 
about a

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family, a story in a letter that I received just a few days ago. It is 
a different aspect of the Affordable Care Act. It is not so much about 
the reduction in the uninsured, but it is about more peace of mind and 
security for the majority of Americans who do have health insurance.

       Dear Senator Kaine,
       As a Senator, you have been charged with an immense task. 
     Your constituents rely on you to work on our behalf to uphold 
     and protect the freedoms we enjoy as Virginians and 
     Americans. We also rely on you to safeguard the legislation 
     that exists to keep our family and so many of our friends and 
     neighbors healthy and safe.
       When I graduated from the University of Virginia, I was 
     fortunate to enter a career through which I received 
     excellent benefits. I taught second grade and kindergarten in 
     both Chesterfield and Albemarle Counties. My health insurance 
     was comprehensive and affordable. I didn't know how good I 
     had it.
       After years in the classroom, I put my career on hold while 
     I stayed at home with our children. We were so lucky to have 
     been in a position to be able to make that choice. I know 
     that being able to rely on a single income is not a reality 
     for many Virginians. We enrolled in a private health 
     insurance plan through my husband's company, a small business 
     based out of Richmond, Virginia.
       Our new plan came at a higher cost than my excellent 
     public-school teachers' insurance, but it was comprehensive 
     and it allowed my husband and me, and especially our 
     children, access to outstanding health care. Just this past 
     year, my husband, who was by then a part-owner in the 
     company, left his position to open his own Financial Advisory 
     firm. It was a move that was made easier because we had the 
     option of enrolling in a health insurance plan through the 
     Affordable Care Act, which we did in July of 2016.
       In addition to well checkups, sick visits, prescriptions 
     for antibiotics, and vaccinations, we rely on our health 
     insurance made affordable through ``ObamaCare'' to, quite 
     literally, save our children's lives.
       Our oldest son is ``medically complex.'' He was diagnosed 
     with multiple and severe food allergies when he was just 10 
     months old. Though he was initially highly reactive to over 
     13 foods, with the help of a vigilant pediatric allergist, 
     multiple blood draws, tens of skin prick tests, and four in-
     office, hours-long oral food challenges, my son can now 
     safely eat all foods except for nuts, peanuts, milk, and 
     shellfish. Still, we pay a premium for life-saving 
     prescriptions that we hope he'll never need: Epi-pens. He 
     needs one at school and one that travels with him from home 
     to extracurricular activities. Even after insurance, we pay 
     nearly $1,000 each year for these prescriptions.
       In addition to his pediatrician and allergist, we have been 
     to a psychologist for his anxiety and a cardiologist for a 
     detected heart murmur. More recently, after his pediatrician 
     became concerned about his stagnation on his growth chart, my 
     nine-year old has been subjected to more blood draws, weight 
     checks, countless hemoglobin level checks, and a consultation 
     with a gastroenterologist. Next week he will undergo an 
     endoscopy and a colonoscopy to, hopefully, diagnose a 
     treatable condition that, once known and treated, will enable 
     him to get back on that weight chart and thriving.
       Because of our health insurance, we have the peace of mind 
     of being able to afford these doctors' visits, lab work, and 
     medical procedures for our son. Our medical insurance through 
     the Affordable Care Act allows us access to the best medical 
     care and professionals in our area.
       Please do what is right for our family. Please do what is 
     right for your constituents. Please do what is right for our 
     country. Please save the Affordable Care Act.
       Thank you for taking the time to read one little piece of 
     our family's story.
       Sarah Harris, Crozet, VA.

  My first story was about people who didn't have health insurance. My 
second story is about people who do have health insurance, but the 
health insurance is now affordable and comprehensive. My second story 
about the Harris family is also about something else important. Her 
husband was able to leave a job with health benefits to start his own 
company, which we want to encourage in this country. We want to 
encourage entrepreneurs. We want to encourage innovators. Before the 
Affordable Care Act, somebody like Mr. Harris couldn't leave his job 
and start a company because he wouldn't have been able to buy insurance 
that would have covered a child with a preexisting condition. Imagine 
being a parent with a dream, like so many have, of starting your own 
business, and realizing you could not achieve that dream and you would 
have to put it on hold because if you changed your job, you would not 
be able to get health insurance for your child.
  I gave a speech about this on the floor last week. I will just 
conclude and say this. Health insurance is to provide a protection for 
you when you are ill or injured, but that is not all it is about 
because if you are a parent, even if your child is healthy, but you do 
not have health insurance, you go to bed at night wondering what is 
going to happen to my family if my child gets sick tomorrow or if I am 
in an accident tomorrow. Who is going to be there? How is my family 
going to be taken care of?
  So what the Affordable Care Act is about is, as Sarah Harris said, 
peace of mind. It is about coverage, but it is also about the peace of 
mind that you need as a parent to know that your child will be 
protected if you are ill or if your child is injured. That is what the 
Affordable Care Act has done for the Harris family of Crozet, VA. That 
is what it has done for tens of millions of Americans.
  The Urban Institute indicated that if the Affordable Care Act is 
repealed without a replacement, or even a delayed replacement, it could 
cause 30 million Americans to lose their health insurance--and 30 
million Americans is the combined population of 19 States in this 
country. This is not a game. This is very, very serious, life and 
death, that we are grappling with in this body. My strong hope is that 
our colleagues will join together and decide that we want to fix and 
improve the health care system of our Nation but not break it.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Minnesota.
  Ms. KLOBUCHAR. Mr. President, I thank the Senator from Virginia for 
his leadership. He recently led a letter which a number of us joined in 
on to suggest that we make reforms to this bill. I said the day it 
passed that the Affordable Care Act was not an end but a beginning.
  But we have not had opportunity, save for just a few examples where 
we changed some tax-reporting provisions under 1099. I was one of the 
people who led the successful efforts to suspend the medical device 
tax--something the Presiding Officer cares a lot about in his home 
State--but in truth, we have not had the opportunity that Senator Kaine 
suggested to make changes to this bill. Instead, we have been faced 
with the thought of just simply repealing this bill, with no 
replacement, with no plan in place. So we would all say to our 
colleagues across the aisle: Show us the plan. Show me the plan. Once 
we see that, we can start talking, but that is not what is happening 
today.
  Additional changes could be made to the act, including increasing the 
amount of subsidies available to exchange enrollees, something 
important in my State; establishing perhaps State-based reinsurance 
programs; doing something about the pharmaceutical prices, something I 
have long advocated for. I have been ready and willing to work with my 
colleagues on both sides of the aisle and to find additional 
commonsense improvements to the law, but repealing without a 
replacement plan is simply unacceptable. It is chaos.
  As my colleague from Virginia reminded us with a touching letter that 
he read from his constituent, let's remember what health care reform 
means to families across this country, why we have this bill in the 
first place. Americans with preexisting conditions, like asthma, 
diabetes, heart disease, and cancer, can no longer be denied access to 
health insurance coverage. Children can stay on their parents' plans 
until they are 26, a dramatic change that helps so many families across 
America. Women are no longer charged more than men for health 
insurance.
  We had a lot of issues when we debated this bill, making sure that 
being a woman or being a victim of domestic violence was not a 
preexisting condition. I see the Senator from Michigan, Ms. Stabenow, 
who fought for maternity benefits. I will never forget the story in her 
committee, when one of the Senators suggested that maybe maternity 
benefits shouldn't be mandatory as part of a plan because he had never 
used them. Without missing a beat, Senator Stabenow looked across the 
table and said: I bet your mother did.
  The point is, we made good changes in this bill that help people. 
There are

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no longer annual or lifetime limits on how much health insurance 
companies will cover. All health insurance plans must now cover a basic 
set of services, which includes mental health care, addiction 
treatment, prescription drug coverage.
  If the ACA is repealed, nearly 30 million Americans could lose access 
to health insurance, increasing the number of uninsured by 103 percent. 
More than 80 percent of these Americans are members of working 
families. In Minnesota, it is estimated that 380,000 fewer people would 
have health insurance in 2019 if full repeal is successful.
  Many Minnesotans have contacted me in the last few months, frightened 
about the future of their health care coverage.
  I heard from a man in Orono. His wife was diagnosed with cancer this 
year. On top of everything his family is now dealing with, he is 
terrified that his family will lose coverage if there is a repeal. He 
wrote to me, begging me to help. He and his family will be bankrupt by 
the cost of his wife's treatment if they lose their health insurance.
  I heard from a 24-year-old young woman from St. Paul. She has a 
chronic disease, and her medication would cost $4,000 a month. Thanks 
to the ACA, she has been able to stay on her dad's health insurance 
plan, which covers a significant amount of these costs. If she isn't 
able to remain on her dad's plan, she will not be able to afford the 
lifesaving medication she needs.
  I heard from small business owners in Aurora. Before health care 
reform, one of the owners had a lifelong preexisting condition and was 
denied access to health insurance. Once the Affordable Care Act took 
effect, she was finally able to purchase coverage through her small 
business. She also qualified for the small business tax credit. She 
reached out to me because she fears she will lose the coverage she 
needs to stay healthy and be able to run her business.
  I heard the story of a woman from Crystal. She works two part-time 
jobs, neither of which offers health insurance. Before health care 
reform, she couldn't afford to go to a doctor. Thanks to the Affordable 
Care Act, she gained coverage through Minnesota's Medicaid expansion 
and was able to get treatments she needed and wouldn't have been able 
to afford without her insurance. Now she is scared she will lose her 
coverage. If the Medicaid expansion is repealed, she knows she will not 
be able to afford any of the treatment she needs.
  These are just some of the heartbreaking stories of people who have 
contacted my office. There are many more. The Affordable Care Act 
repeal will have real consequences for families in Minnesota and across 
the country, but families aren't the only ones who will see the 
negative impacts. They are going to see it through rural hospitals. 
Health care reform provided a lifeline to these hospitals by extending 
coverage to millions of patients who can now get prescription drugs and 
treatment without having to turn to emergency rooms for assistance. 
This lifeline was helpful in three ways.
  First, the health care reform law included a provision to extend 
prescription drug discounts--between 25 and 50 percent--to over 1,000 
rural hospitals through the 340B Program. The RiverView Health facility 
in Crookston used the savings from the 340B Program to recruit 
orthopedic surgeons and oncology specialists, update equipment, start a 
clinic, and start a 24/7 onsite lab.
  Second, the Medicaid expansion, under health care reform, provided 
coverage for millions of previously uninsured patients in rural States. 
This means crucial new revenue for rural hospitals.
  Third, health care reform enabled nearly 2 million rural Americans, 
including in my State, to purchase subsidized private coverage on 
exchanges last year alone--which is an 11-percent increase from 2015. 
Even with these gains, the National Rural Health Association recently 
said that most rural hospitals have been ``operating on a break-even 
margin or at a loss in certain cases.'' These hospitals can't afford to 
see a repeal of the ACA with no replacement that works for them.
  As we look to improvements, I would mention a few things with 
prescription drug prices. According to a 2016 Reuters report, prices 
for 4 of the Nation's top 10 drugs increased more than 100 percent 
since 2011. The report also shows that sales for those ten drugs went 
up 44 percent between 2011 and 2014, even though they were prescribed 
22 percent less. In any given month, about half of all Americans and 90 
percent of seniors take a prescription drug.
  So what has happened? The price of insulin has tripled in the last 
decade. The price of the antibiotic doxycycline went from $20 a bottle 
to nearly $2,000 a bottle in 6 months. As was pointed out, naloxone, a 
rescue medication for those suffering from opioid overdose, was priced 
at $690 in 2014 but is $4,500 today. This is a rip-off, and this cycle 
can't continue. A recent study showed that one in four Americans whose 
prescription drug costs went up said they were unable to pay their 
medical bills. They are skipping mortgage payments. They are not being 
able to pay their bills.
  So what are some solutions? I recently introduced and am leading a 
bill, with a number of other Senators, for negotiation for prices under 
Medicare Part D. The President-elect has voiced support for this kind 
of effort. Let's get it done.
  Secondly, drug importation. Senator McCain and I introduced and 
reintroduced our bill again, which allows for less expensive drugs to 
come in from Canada so we finally have some competition. It would 
simply require the FDA to establish a personal importation program that 
would allow Americans to import a 90-day supply of prescription drugs 
from an approved and safe Canadian pharmacy. We wouldn't need this if 
we didn't have these escalating prices.
  Third, Senator Grassley and I have a proposal to crack down on pay-
for-delay that prevents less expensive generic drugs from entering the 
market.
  Finally, Senators Leahy, Grassley, Mike Lee, and I have introduced 
our bipartisan Creating and Restoring Equal Access to Equivalent 
Samples Act, to make it easier for generics to enter the market and 
stay in the market. The answer to this is competition, and we are not 
going to have competition if we deny access to that competition.
  In conclusion, no family should be forced to decide between buying 
food and filling a prescription or paying the mortgage and taking a 
drug as prescribed. It is time to pass legislation to ensure that 
Americans have access to the drugs they need at the prices they can 
afford. I am more than happy to talk to my colleagues about some of 
these proposals, but we simply cannot repeal this bill with no plan on 
the table to replace it.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Pennsylvania.
  Mr. CASEY. Mr. President, I rise this evening to speak about the 
Republican effort in the Senate, by way of a budget resolution, which 
includes so-called reconciliation instructions to repeal the Patient 
Protection and Affordable Care Act, in this case, unfortunately, 
without any replacement for that legislation we passed a number of 
years ago.
  In a word, I think this is a plan for chaos--chaos certainly for 
insurance markets but more particularly chaos and damage done to 
middle-class families whose costs will go up. Of course, their coverage 
will be affected adversely. A repeal act without replacement would 
raise the price of prescription drugs for older Americans across our 
country, put insurance companies back in charge of health care, cost 
our economy millions of jobs, and devastate funding for rural hospitals 
and rural communities in Pennsylvania and across the country.
  I think, on a night like tonight, where we are just beginning a long 
debate about how to bring affordable care to Americans and how to 
continue that, we should reflect back on where things were before the 
Patient Protection and Affordable Care Act.
  Over 50 million Americans were uninsured in 2009--50 million people. 
People with any sort of medical condition were routinely denied health 
insurance

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or were charged exorbitant rates because of their health histories. 
Women in the United States were routinely charged more than men for 
their health insurance. This is not an exhaustive list. Finally, 
individuals who were ill were routinely dropped from their health care 
coverage because they had reached arbitrary caps on the amount of care 
an insurer would pay for a given year.
  So let us talk about what has happened since then. Since the passage 
of the Affordable Care Act in 2010, we have come a long way. More than 
20 million Americans, including almost 1 million in Pennsylvania, have 
received health insurance as a result of this one piece of legislation. 
One hundred five million Americans are protected from discrimination 
due to preexisting conditions. Those are 105 million Americans with 
preexisting conditions who are no longer barred from treatment or 
coverage as they were before. Nine million Americans have received tax 
credits to help them cover the cost of their insurance. Eleven million 
seniors have saved over $23 billion from closing the Medicare Part D 
prescription drug plan's so-called doughnut hole. Doughnut hole is a 
benign way of saying burn a hole--costs that were burning a hole in the 
pockets of America's seniors.
  Finally, hospitals in States like Pennsylvania are getting a lot of 
help due to the legislation. In Pennsylvania, our hospitals have saved 
$680 million due to reductions in uncompensated care. I think, in the 
end, most of this is about real people and real families and their real 
lives and, unfortunately, the real consequences that would adversely 
impact their lives.
  Among the 3 million Pennsylvanians with preexisting conditions, there 
are two remarkable young women whose mother first contacted me in 
2009--Stacie Ritter, from Manheim, PA. Stacie is a mother of four 
children, including twin girls, Hannah and Madeline. That is a picture 
of Hannah and Madeline a number of years ago. Hannah and Madeline were 
diagnosed at the age of 4 with a rare and dangerous type of leukemia, 
at such a young age.
  Stacie and her husband went bankrupt. They literally went bankrupt 
trying to pay for their daughters' medical bills. She wrote to me at 
the time, saying that without health care reform ``my girls will be 
unable to afford care, that is if they are eligible for care that is 
critically necessary to maintain this chronic condition. Punished and 
rejected because they had the misfortune of developing cancer as a 
child.''
  So said Stacie Ritter, one mother in one community in Pennsylvania in 
2009. She was talking about her daughters being punished and rejected, 
as if they had any control over the cancer they were diagnosed with. 
Fortunately, Hannah and Madeline are healthy young women today. 
Madeline and Hannah are freshmen at Arcadia University and are doing 
well. The Affordable Care Act protects them by assuring they will have 
access to affordable coverage, whether on their parents' plan or on a 
plan in the market. Because of their medical histories, they have 
ongoing health care needs, and they don't know what they would do 
without the Affordable Care Act.
  Here is a picture of them today, and you can see what a difference 
health care makes in the life of a child--in this case, the life of two 
children who are now young women and in college. I don't even want to 
think about it, but we should think about what would have happened 
without this legislation. We should not ever put children and their 
families in that circumstance.
  If you are talking about a new plan, you better have a plan that 
would cover children like Hannah and Madeline, and you better be able 
to pay for it. You can't just talk about it. You can't just promise it. 
You have to be able to pay for it, as we did in this legislation.
  While we are on the question of costs, let's talk about it in human 
terms--human terms meaning young women like Hannah and Madeline. We 
have heard an awful lot from Republican Members of the Senate and 
Republican Members of the House of Representatives. They have been 
promising to come up with a ``better plan'' than the Affordable Care 
Act since 2010. Since March of 2010, when this passed, you would think 
that by now they would have a plan--a plan that would replace what they 
had repealed. That is part one. Part two is a plan that is better, 
because that is what they promised. They used other words to describe 
it as well.
  Now almost 7 years later--and it will be 7 years in March--where is 
their plan? I don't think anyone has been able to find their plan. Some 
Members of the Senate on the Republican side of the aisle have said 
recently that they have a plan but they haven't released it yet, or 
they have parts of a plan or different plans but they are putting them 
together, and we will see them soon. Others don't seem to know whether 
there is a plan or not. So they promised to replace the Affordable Care 
Act only after they repealed it and only after millions of Americans 
would lose their insurance.
  Where is the plan after 7 years? You would think, if you were serious 
about a matter of public policy--something as substantial and as 
consequential in the lives of families--that after 6-plus, almost 7 
years you would have a plan ready to go, and that plan would be 
comprehensive, and that plan would cover at least 20 million people, 
maybe more.
  That plan would have all the protections that I spoke of earlier. 
Young women like that, when they were children, would not have their 
treatment capped. Someone with a preexisting condition would be 
protected. Women would not be discriminated against. All of those 
protections, including the coverage, would be part of that plan--you 
would think.
  It seems as if to find the Republican plan here in Washington, you 
would need to hire a really good private investigator to look in every 
corner of Washington. Maybe it is in some of the desks here. Maybe we 
just haven't found it yet. So far, there is no plan--no plan. There is 
a lot of talk and a lot of hot air about repeal but no plan.
  What does the Brookings Institution say? They say that the number of 
uninsured Americans would double if the act is repealed. To be precise, 
that would leave 29.8 million people without insurance. It would go 
from 28.9 to 58.7 million people. I started tonight talking about 50 
million uninsured in 2009. If you repeal this legislation and you don't 
replace it with something that is very close to comparable, that means 
you no longer have 50 million uninsured like we did in 2009, you have 
58.7 million--let's round it off to 59 million Americans without 
insurance--despite all the gains we have made in the last number of 
years.
  What does that mean for Pennsylvania? Since the bill was passed, 
956,000 Pennsylvanians stand to lose their coverage because that is how 
many have gained it. The Congressional Budget Office, which is the 
Congress's referee or scorecard, estimates that insurance premiums 
would rise by 20 percent if the act is repealed without a replacement.
  The Commonwealth Fund, in a recent report, estimated that repealing 
the act would cost our economy 2.5 million jobs per year--not over 5 
years or 10 years but 2.5 million jobs per year.
  Pennsylvania is a State where, despite having huge urban areas in 
both Philadelphia and Pittsburgh and a lot of cities in between, we 
have millions of people literally that live in so-called rural 
communities, rural counties. By one estimate of our 67 counties, 48 of 
them could be categorized as rural counties. We have a lot of people 
who live in, make their living in, and work very hard in rural 
communities.
  One of the headlines that caught my attention last week was from the 
Fiscal Times. This is from January 5. You can't see it from a distance, 
but the headline reads: ``Obamacare Repeal Could Push Rural Hospitals 
to the Brink.'' It is all focusing on rural hospitals and the cost of 
repeal.
  We know that a couple of years ago there was a report by First Focus 
that focused specifically on rural children and their health care. Here 
is what the conclusion of that report was. As of 2012, the year they 
examined, Medicaid and the Children's Health Insurance Program covered 
47 percent of rural

[[Page 446]]

children, compared with 38 percent of urban children. Almost half of 
rural children, as of this report, received their health care from 
Medicaid or the Children's Health Insurance Program. Both would be 
adversely impacted by both the repeal of the Affordable Care Act and 
the implementation of the House Republican budget, which I think is the 
most extreme budget ever proposed in Washington.
  That is the reality just for rural children and their health care 
and, also, the predictions about what will happen to rural hospitals. A 
lot of people employed in Pennsylvania--tens of thousands--are employed 
in rural hospitals in our State.
  One of the individuals who contacted us to talk about this issue in 
the context of being in a somewhat rural community but someone who is 
actually doing farming--and, of course, farming does not occur just in 
rural areas--is Julia Inslee, from Coatesville, PA. That is in 
Southeastern Pennsylvania, where we have a lot of farms, as well, just 
like we do in the middle of the State and in the western, northeastern, 
and northwestern part of the State. Julia turned her family's hobby 
farm into a full-time operation. Here is what she wrote to her office 
in November.

       I am one of the millions of people who have benefited 
     greatly from affordable access to health care. I work part 
     time as a tutor at a community college and nearly full time 
     as a farmer. Neither one of these jobs provides me with 
     health care, nor do I make enough to pay several hundred 
     dollars in premiums per month. The government subsidy is what 
     makes it possible for me to have healthcare. If Obamacare is 
     taken away, I will most likely have to give up farming, and 
     if anything, we need more farmers, not fewer.

  That is what she says. ``If Obamacare is taken away, I will most 
likely have to give up farming.''
  Why would we do that? Why would we say that to someone who has 
achieved success in any profession or any job or any career--but 
especially something as fundamental to the economy of Pennsylvania? By 
one estimate, our largest industry is agriculture in Pennsylvania. Why 
would we say to that farmer: They have this idea to get rid of 
legislation in Washington. You are just going to have to come up with a 
new profession. Why would we force people to give up farming in order 
to meet the demands of some people in Washington?
  Julia is facing the likelihood, if the act is repealed, of losing her 
ability to support herself because her insurance would be too 
expensive.
  I have to ask: Is this a ``better plan''? Is this what Republicans 
have come up with? We shall see.
  Rebecca Seidel is a dairy farmer as well. She is from Douglassville, 
PA. Rebecca co-owns a herd of dairy cows, and she talked with me just 
last week about how dangerous farming can be and how scary it is not to 
have insurance. She says:

       As the daughter, granddaughter, and great-granddaughter of 
     Pennsylvania dairy farmers, I've seen my share of 
     agricultural catastrophes. Between equipment and large 
     animals, every day comes with potential hazards. Will I break 
     a rib getting between two cows who are fighting? Will a blade 
     come loose from the bedding chopper and hit me? Will my hand 
     be broken through miscommunication with someone operating the 
     skidloader? These are realities with which I live every day 
     and I am able to go about my job bravely because I know none 
     of these events would financially destroy my family.

  She said the Affordable Care Act allowed her to work, and she wrote:

       Threats to the ACA are threats to our future, Senator, and 
     to the future of small businesses, agriculture, and families.

  Rebecca and her husband don't know what to expect with repeal of the 
law. They want to start their own business, allowing their current 
employer to hire more people, but they don't know what they will be 
able to afford in such an environment of uncertainty. Rebecca and her 
husband don't know if they will be able to realize their plans to start 
a new business. How is this a better result for them, we would have to 
ask.
  Finally, we have a story of a businessman, Anthony Valenzano. Anthony 
is a small business owner who has been successful with the hard work of 
one employee who purchases an affordable and comprehensive plan through 
Pennsylvania's health insurance marketplace. This is what Anthony said 
as a small business person:

       It is my opinion that the Affordable Care Act is the best 
     thing the federal government has ever done for a real small 
     business like mine. This bill paved the way for entrepreneurs 
     to strike out on their own, knowing that they have a way to 
     get health insurance. The bill allowed these entrepreneurs to 
     attract professional employees who would otherwise have never 
     left a corporate job to join a small startup.

  His business relies on his one employee--in this case, he has one who 
is central to his business--being able to purchase affordable health 
insurance, since, with only one employee, he cannot get her on 
employer-sponsored coverage. He said, ``Looking forward, we plan to do 
even bigger and better things, but she still needs health insurance to 
do it, and if we lose the Marketplace, iQ Product Design will likely 
lose its key employee and will be unable to create the next big market-
changing product.''
  He is asking: What is going to happen? Is there a replacement plan? 
What happens to his employee? What happens to his business? We have a 
long way to go to debate these issues. But I have to ask again, if 
there is such a better idea here after almost 7 years now, where is 
this replacement plan? We haven't heard one word about the details of 
it. Where is it? I think that is what a lot of Americans are asking. We 
know what Republicans want to do: Repeal the Affordable Care Act or 
patient protections in the Affordable Care Act for all those people 
with insurance who had much better protections solely because of this 
legislation.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Michigan.
  Ms. STABENOW. Mr. President, first I want to thank my good friend and 
colleague from Pennsylvania who serves with great distinction with me 
on the Agriculture Committee. I love that he is speaking about our 
farmers. In a few minutes, I am going to talk about Sonya, who is a 
blueberry farmer and small business owner from Michigan. We know there 
are so many small business owners and farmers who finally have been 
able to find affordable health care because of what was passed in the 
health care reform act.
  I want to thank Senator Casey for being such a strong advocate for 
those dairy farmers. We have a few dairy farmers in Michigan, as well, 
and we appreciate very much his advocacy.
  I want to take a step back and look broadly for a moment at what is 
really happening here and why we are so concerned and why we have spent 
all of this evening and are going on into the night to talk on behalf 
of the people we represent on the impact of what repealing the 
Affordable Care Act without having a replacement that is as good or 
better in place at the time would really mean for people.
  Republicans get sick. Democrats get sick. Independents get sick. 
People who don't vote get sick. This is not a partisan issue. This is 
about one of the most basic human needs, most basic things that we care 
about for our families. People go to bed at night and say: Please God, 
don't let the kids get sick. Make sure Mom is OK, Dad is OK.
  Because of the Affordable Care Act, because of the increases in 
access to affordable health care that we were able to pass a number of 
years ago, fewer people are having to worry. There are still people 
worrying, and there are still issues. There are still costs, and there 
are still things to do. I am anxious to get about the business--all 
Democrats are anxious to get about the business of making sure that 
health care is more affordable and doing more to bring down the cost of 
prescription drugs. I am also concerned about small businesses. There 
are things that we can do together, that we should be doing on a 
bipartisan basis, but we shouldn't be repealing health care and 
unraveling the entire system and creating chaos in the entire system 
instead of focusing on how we make health care better for families.
  The bottom line of what is being proposed--and what this budget 
resolution is really all about--is going to make America sick again. 
That is the bottom line. We are going to create a situation where more 
Americans will be sick and

[[Page 447]]

not be able to see a doctor, not be able to find affordable insurance, 
or not be able to have the protections that they currently have under 
what we like to call the Patient's Bill of Rights--the patient 
protections for everybody. Seventy-five percent of Americans get their 
health insurance through their employer, and every one of them--all of 
us--have benefited from changes in health care that have taken total 
control out of the hands of insurance companies and given us more 
assurances that if we get sick, we are not going to get dropped. If we 
have an illness or our child has juvenile diabetes or cancer or 
Alzheimer's or leukemia or high blood pressure or if you are a woman of 
child-bearing age, which is viewed as a preexisting condition so you 
have higher rates--all of those things were changed in the interest of 
the American people.
  Basically, when we look at it, there are four different areas where 
health care reform has made a difference in people's lives and what we 
are fighting for tonight. We are fighting for these things. We are 
fighting to have them not taken away and to have the system not ripped 
up and not create a situation where we cause incredible harm by what 
Republican colleagues are talking about doing.
  The first general category is putting insurance companies back in 
charge by repealing the patient protections. That is what is being 
talked about: keeping young people, your son or your daughter, on your 
insurance until age 26. They graduate from college; they probably 
already have mounds of debt. Letting them get started in the workplace 
and stay on your insurance has made an incredible difference for 
hundreds of thousands of young people across the country. That is gone.
  Guaranteed access to essential health benefits. I did fight very hard 
so that we had a benefit package that includes simple things, important 
things for women, like maternity care. Prior to health care reform, 
about 70 percent of the insurance policies that were available in the 
private market--if a woman were to go out and try to find insurance, 
about 70 percent didn't provide basic maternity care. Now all the 
policies have to provide maternity care. Policies have to include 
mental health and addiction services like physical health, so we are 
saying that if you have an illness above the neck, it ought to be 
treated the same as an illness below the neck. These are patient 
protections for all of us.
  In health care today, you can't have your services capped. I have 
seen and spoken with so many doctors who treat cancer in children and 
adults. Families talk about the fact that in the past there would be a 
financial cap or a number of visits or a number of treatments as a 
limit, and if you were done with your treatment and your doctor didn't 
feel that you received enough treatments, too bad. Your yearly cap is 
up or the lifetime cap is up. Right now, that is gone. But with the 
repeal, those caps come back.
  Preventive services with no copay. We want folks getting a wellness 
visit, getting a mammogram, being able to get contraceptive coverage, 
being able to get preventive cancer screenings. Doing that without a 
copay has made a tremendous difference in people being able to get the 
preventive care they need.
  There are so many other things that have been put in place for 
everyone who has insurance. All of that gets ripped away with repeal, 
and there is no excuse for that. There is no way we are going to allow 
that to happen without continuing to fight as hard as we can. It is 
outrageous.
  The second thing is cutting Medicare and Medicaid. All of the health 
care system is tied together. When we made changes in Medicare, we 
lengthened the solvency of the trust fund--12 more years of solvency in 
the trust fund, 12 more years of making sure it is solid, financially 
viable. That goes away.
  My colleagues have talked about prescription drugs and the fact that 
we have closed this gap in coverage. If you have high bills related to 
the cost of medicine, right now you are covered. When you get to a 
certain point and there is a complete gap in coverage and you are not 
covered anymore, and then you are covered again--folks call that the 
doughnut hole. We are closing that so there is no gap in coverage.
  With repeal, the doughnut hole comes back. Coverage is lost. Costs 
for medicine go up. Preventive services under Medicare are ripped away 
if we see a repeal. And there is not a replacement that is put in place 
that is equal to or better than what we currently have.
  Medicaid. We have so many people who are working for minimum wage, 
working really hard at minimum wage jobs, who never had the opportunity 
to have health insurance before, and now they do. That is gone if the 
whole system is ripped up. Most of Medicaid goes for seniors in nursing 
homes, long-term care. If you look at the nominee for Secretary of 
Health and Human Services, who has proposed completely rewriting, 
ripping up Medicare as we know it, as well as health reform and the 
Affordable Care Act--if you put all that together with this repeal and 
somebody who wants dramatic changes--I believe it is $1 trillion in 
cuts proposed by the current chairman of the Budget Committee or the 
gentleman who now is being proposed for Secretary of Health and Human 
Services--Medicare and Medicaid are seriously threatened by all that is 
talked about right now.
  We are talking about, in total, kicking 30 million Americans off 
their insurance. In Michigan, all together, counting Medicaid and those 
who are purchasing through the new insurance pools, it is over 2 
million people. One out of five people in Michigan and their families 
will lose their access to a doctor and medical care.
  What does all of this mean? It means costs are going to go up both 
for coverage and prescription drugs. And for Republican colleagues who 
say: Well, we are going to repeal it now, but not really because we are 
going to say it is repealed and then we are going to wait 2 or 3 
years--first of all, Republicans have had 6 years of talking about 
repeal. It has been over 50 times in the House of Representatives. You 
would think within that time they would have been able to come up with 
a plan, not a bunch of ideas but a plan to show that, in fact, these 
things aren't going to happen; that they are not going to unravel the 
health care system; that they have something bigger, better, greater, 
but that is not what we are hearing. We are hearing: Well, we don't 
have it yet; we don't know if we are going to have it. We will try to 
figure it out somehow, and we will wait 2 or 3 years.
  What happens in the insurance market when insurance companies don't 
have predictability? Rates go up. What happens when hospitals--and I 
have already been told this in Michigan--don't know what is coming? You 
pull back. You pull back on investments. You pull back on what you are 
doing in terms of coverage because you don't know what is coming.
  This makes no sense whatsoever. I understand politics. I understand 
slogans. I understand all the rhetoric that has been said for years 
about repealing health care reform, but this is the most irresponsible 
thing I have ever seen in my life if there is a repeal with no 
replacement immediately that at least equals what people have today--
the protections, the coverage, the strengthening of Medicare, the 
lowering of prescription drug prices under Medicare, the help for 
people who work hard every day on minimum wage and are finding access 
to a regular doctor instead of using the emergency room, which, by the 
way, raises health care costs.
  The truth is, we all are here because we care deeply about this. If 
our colleagues want to stop this craziness of running the cow off the 
cliff and decide that maybe we are going to work on just fixing it 
together, we are ready, willing, and able to do that. We know, as with 
any major change in form, that after they work a while, you have to 
figure things out and you have to fix problems. We are more than 
willing; we want to do that. We have been offering to do that and 
suggesting that for the last several years. But this approach is 
outrageous and completely irresponsible, and, in fact, it will make 
America sick again.

[[Page 448]]

  Let me conclude by just sharing a couple of stories from constituents 
in Michigan. I have heard from a lot of people, particularly small 
business owners, people who have the freedom now to be able to leave 
their job where they were working only because of the insurance. That 
has happened to my own family and friends, where folks are in a job 
that does not work for them but at least they have insurance.
  The Affordable Care Act has given the flexibility for someone to step 
away, to be able to start their own business or their own farm, like 
Sonia who is a blueberry farmer in Michigan. She has written me, 
indicating they are extremely fearful that they are going to lose their 
insurance under the new administration because of what Republicans are 
talking about.
  She says:

       A number of years back in 2000 I quit my traditional job 
     and my husband, who had been laid off, and I bought my step-
     dad's blueberry farm. He had passed away in 1995, and we took 
     care of my mom who had inherited the farm, and lived with us 
     for a year and a half until her death. We are full-time 
     farmers, small farmers, about 15 acres of blueberries. We 
     also have a small garden center, Sweet Summer Gardens, which 
     is open from May to September, and a small bead store, the 
     Enchanted Bead. It is open year round.

  She says:

       We are hard-working people who love the life that we have 
     carved out for ourselves, but there some drawbacks to being 
     self-employed and small business owners. In 2012, I tore the 
     meniscus in my right knee. I did nothing to take care of it 
     because I did not have insurance. But then in April of 2015, 
     3 years after the injury, I finally got to the point where I 
     could no longer take the pain. Luckily, we had signed up for 
     insurance through the Affordable Care Act. I was able to have 
     the severe tear repaired.

  Then she goes on to talk about how a little later there was a cancer 
scare, and she had to go in for ultrasounds and lab work and an 
outpatient D&C.
  Because she was able to do that, she was fortunately able to find out 
it was not cancer, thank goodness. Again, because of the Affordable 
Care Act and her insurance, she was able to get the services she 
needed. She goes on to talk about a number of different health 
challenges for them, including the following:

       Finally we have coverage for preventive care. My husband 
     had a physical, the first time since high school, and we 
     found out that there was an issue that needed to be 
     addressed. He was referred to an orthopedic surgeon, 
     discovered he had severe arthritis. It was causing constant 
     pain. Again, we were able to have insurance coverage. Because 
     of the Affordable Care Act, he was able to have this 
     repaired.

  She says:

       We are hard-working people. We have never asked for help. 
     But we are extremely concerned because we could not afford 
     our insurance right now without the tax credits--the subsidy.

  She says:

       This morning, watching the news, we were met with a story 
     that the Republicans are all ready to repeal ObamaCare. They 
     said that while they couldn't take away the insurance, they 
     could take away the subsidies. This would put insurance out 
     of our range and we would no longer be able to afford it. My 
     husband Larry said to me, ``they couldn't just throw us out 
     to the dogs, could they?''

  She says:

       My reply was, ``anything is possible.''
       I know the Affordable Care Act isn't perfect. I know that 
     not everyone has taken advantage of it, but there has to be a 
     way to fix it without hurting the millions of people who have 
     been helped by it.

  In fact, Sonia, there is a way to fix it without hurting you and your 
husband, full-time farmers and small business owners. I have a number 
of other stories. I am going to pause because I have other colleagues 
who I know want to speak who care deeply about this as well. I will 
share those at a later point.
  Let me just say, what we are talking about is not a game. It is not. 
This is about real people with real lives who are encountering 
situations that could happen to any of us. Too many people are not in a 
situation, without Medicare or Medicaid coverage or access to health 
care through the exchanges, to be able to see the doctor and get the 
care they need. That has changed in the last number of years.
  There is more to do. We can work together to make it even better, but 
the idea that people are not being helped today, that small business 
owners and farmers and families are not getting medical care today 
because of what was done is just not true. It is just not true. The 
reality is, we are in a better spot with more to do. Pulling the thread 
and unraveling the entire system and creating chaos in the entire 
system makes no sense.
  So we as Democrats are going to do whatever we can. We know that 
ultimately the votes are there. If the Republicans in the House and the 
Senate and the new President want to completely dismantle the health 
care system, unravel the health care system, weaken Medicare, and 
weaken Medicaid, you can do it. You have the votes to do it.
  People right now who get care, the millions of people, the over 2 
million people in Michigan alone who have been directly helped by the 
Affordable Care Act, they know that. They will know when that is no 
longer available to them. It will hurt many, many people. We hope 
colleagues will take a second look and decide to work with us in a way 
to move forward on health care that will allow people to get the care 
they need at an affordable price for themselves and their families.
  I know that is what we all want for our families. We should be doing 
everything humanly possible to make sure people have the affordable 
care they need and the protections they need to get care when they need 
it.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Colorado.
  Mr. BENNET. Mr. President, I would like to welcome the Presiding 
Officer to the Senate and just say thank you very much for your 
willingness to sit here this evening. To my colleagues, thank you for 
being here. The hour is getting late so I am not going to take up a lot 
of time with my own words, but I did want to come to the floor and read 
the words of people who have written my office, Coloradans who took the 
trouble to tell me what their concerns were with this suggested repeal 
of the Affordable Care Act.
  Given the fact that they took the time to write, I wanted to have the 
opportunity to be here tonight to read their words into the Record. It 
matters to a lot of people in my State because more than 600,000 people 
are now insured in Colorado who were not insured before the Affordable 
Care Act. We have had one of the largest drops of the uninsured rate in 
the country. We have dropped from 14 percent to 7 percent, really 
importantly from the point of view of saving money. The amount of 
uncompensated care has gone down by 30 percent. So those are at the 
hospital. Those are statistics, but the letters tell the human 
dimension, the human story that so often is lost in the Chambers of 
this Capitol.
  A letter from Kathryn from Denver who wrote:

       The Affordable Care Act has been crucial to my family the 
     last several years. . . . My sister, a Type 1 diabetic since 
     age 10, is now a Colorado business owner.
       The Affordable Care Act allowed her to pursue business 
     ownership because--for the first time in her life--she could 
     get individual health insurance coverage without being denied 
     due to her preexisting condition. ACA allowed her to leave 
     her full-time job and start a part-time business and get 
     benefits through ACA.
       I truly believe so much good has begun to come from this 
     legislation and repealing it will have catastrophic 
     consequences for my family and for so many others.

  Terry from Denver writes:

       I am writing concerning the Affordable Care Act (ACA). In 
     2010, I left my conventional job and took a risk, forming a 
     company to perform engineering consulting services. Since 
     that time, I have helped multiple organizations improve the 
     safety and reliability of their products and consider my 
     efforts to be quite successful.
       However, I would not have taken the chance to go off on my 
     own if it had not been for the Affordable Care Act (ACA).
       The ACA gave me options in health insurance that I would 
     not have had prior to its passage. There are millions of 
     people like me who count on the security of the ACA. These 
     people are entrepreneurs, freelancers, the self-employed, 
     early retirees, and the like who would not have health 
     insurance if not for the ACA.
       Therefore, I am asking you to continue your support for the 
     ACA.

  Catherine, a nurse from Aurora:

       I want to tell you a personal story, in the hopes that you 
     will think about the people in

[[Page 449]]

     your state who might be affected if the Affordable Care Act 
     is repealed.

  That is whom we are here to talk about tonight. That is whom we are 
here to think about tonight. Catherine wrote:

       I have a daughter with Schizophrenia. . . .
       When we had to bring her home from college, we were 
     terrified about what might happen to her and where she would 
     find treatment.
       Because of the Affordable Care Act, she was able to stay on 
     our insurance for the next 3 years, even though she was no 
     longer a student.

  That is one of the most popular provisions of the Affordable Care 
Act.

       Although it was a long process and not easy, we were able 
     to help find quality mental health care providers and her 
     care was covered because of provisions in the law that 
     provided for mental health coverage.

  Provisions that I know the Senator from Michigan worked on.

       She is now doing very well. She is married and able to work 
     part time and function as an active member of society.
       As a nurse, I have cared for many people over the years who 
     had chronic conditions through no fault of their own. Before 
     this law was passed, many would not get insurance, or if they 
     did, the cost was beyond their reach.

  Nicholas from Denver:

       My wife was diagnosed with stage IV colon cancer at the age 
     of 38, almost 4 years ago. We have been living with it as a 
     chronic disease and she is in stable condition.
       Health care costs have been about $15,000 a year for us out 
     of pocket, but we've been able to manage because of the 
     protections afforded by the ACA, specifically no caps on 
     annual or lifetime benefits and no denials for preexisting 
     conditions. . . .
       Please assure me you will do all you can to keep those 
     protections we so desperately rely on from disappearing.

  Sarah writes:

       On June 20, 2016, my second child, my daughter Emma, was 
     born. . . . She was born six weeks early and weighed 3 lbs. 
     10 oz. At birth. We knew prior to her birth that she had a 
     heart defect (a hole in her heart) that would need to be 
     repaired through open-heart surgery during the first year of 
     her life.
       We also knew that she wasn't growing properly and she might 
     have other issues. . . . During the past five months, Emma 
     has undergone more surgeries and procedures than most people 
     will undergo in their entire lives. . . . I haven't recently 
     tallied the cost of Emma's medical care, but I believe she 
     will easily reach $1 million (or much) in medical expenses 
     before she turns 1.
       I have become extremely anxious about how my family will 
     meet Emma's ongoing needs if the ACA is repealed and 
     insurance companies are allowed to reinstate lifetime 
     maximums and to discriminate against preexisting conditions. 
     . . .
       I beseech you to do everything you can to preserve the 
     provisions that will help my family--and to do everything 
     possible to ensure that the millions who have finally been 
     able to acquire health insurance since the ACA was passed 
     don't lose their insurance.

  People have received probably hundreds of thousands of these letters 
in the Senate. It seems to me--I mean, yes, we should be having a 
conversation about how to make the law better. I have said from the 
very beginning that I don't think it is perfect. I think there were big 
problems with our health care system before we passed the Affordable 
Care Act. I think there are big health care problems with our health 
care system today. That is a fact that anybody in America ought to be 
able to notice. And the Senate ought to be able to notice that and say: 
Why don't we make it better? Why don't we improve it? We should improve 
it.
  I would love to meet with colleagues here to talk about how we deal 
with the fact that in rural Colorado, there is not enough competition 
in health insurance for people. I would love to be able to have a 
conversation here about how to drive the cost of insurance down in 
rural Colorado, rather than continue to see those costs increase.
  I would say this. If there is somebody here with a solution to that 
problem, on either side of the aisle, I would be happy to write that 
amendment with them. But the problem I have with where we are in this 
debate--and I will close with this--is that we are talking about 
throwing out all the protections that all of these people have come to 
rely upon, that all of these people have come to count on in America 
with our health care system. We are going to throw them out, but we are 
not going to tell you what we are going to put in its place. In fact, 
for all you know, we are not going to put anything in its place because 
what we have heard is that there is no consensus on the other side 
about how we should move forward.
  Part of the problem I have had with this legislation since the 
beginning is that we have been unable to forge a bipartisan consensus 
on how to deal with the fact that this country is spending 16 percent 
of its GDP on health care when every other industrialized country in 
the world is spending about half that or, in some cases, less than half 
that and delivering better results. I would love to see a bipartisan 
consensus. But what we have come to understand in the days leading up 
to this debate is that there is not a consensus on the Republican side 
about how we should go forward.
  After 7 or 8 years, you would think we would have the opportunity to 
see a plan. It is not hard to think about what the values would be 
underlying a plan--the values that would say: Let's try to maximize 
coverage where we can. Let's try to increase quality where we can. 
Let's try to drive prices down where we can. Let's try to spend less, 
as a country, on health care where we can.
  Those are not Democratic or Republican ideals. It would seem to me 
that those values would have the virtue of being able to inform 
Democratic pieces of legislation and Republican pieces of legislation. 
But in 8 years, we haven't seen a plan.
  Here we are tonight, talking about repealing the protections that 
Coloradans are counting on every single day for their peace of mind and 
so they can plan for the sake of putting nothing in its place. It 
reminds me--and, colleagues, I will close with this--of the complaints 
that I have had in my office and as I travel the State of Colorado, 
where people say: Michael, we paid into our health insurance company. 
Month after month after month, we paid our premiums. Then, when my kid 
got sick and I called them up, their response was to keep me on the 
phone as long as possible without an answer in the hope that I would 
give up and go home and that the claim wouldn't have to be paid.
  To be honest, colleagues, I have heard that before we passed the 
Affordable Care Act, and I have heard that since we have passed the 
Affordable Care Act. We have more to do. That is the honest thing to 
say here.
  But for us to talk about repealing this, taking away the benefits 
that people have, the protections that people have, the security and 
peace of mind that people have, and replacing it with the equivalent of 
leaving the American people on hold so they will give up, so they will 
move on to the next thing is beneath the dignity of this place and is 
not worthy of the Members of the Senate.
  I want to close by saying what I have always said. I will work with 
anybody--Democrat or Republican--to make sure that we really do have 
affordable health care in this country for the American people, for the 
people whom I represent in Colorado, and I look forward to our getting 
to a place where that is the politics we are pursuing in this Chamber, 
instead of the politics we have seen over the past number of years.
  With that, I yield the floor.
  The PRESIDING OFFICER. The Senator from Wisconsin.
  Ms. BALDWIN. Mr. President, I rise this evening to join my 
colleagues--Democrats, Independents--to fight together to protect the 
health and economic security of the American people.
  In 2012, when I was elected to the Senate, I can assure you that the 
people of Wisconsin did not send me here to take their health care 
away.
  We are barely into the second week of the new Congress, and the 
Republican establishment is already wielding its power to accomplish 
just one thing, making America sick again.
  The budget resolution that we are considering this week will repeal 
the Affordable Care Act, put insurance companies back in charge of 
people's health care, strip health care away from millions of 
Americans, and raise premiums. It will take us from affordable coverage 
to chaos.

[[Page 450]]

  This is the first step toward higher costs, fewer people with health 
insurance, and more uncertainty for American families. In short, the 
Republicans believe they have a mandate to make America sick. By 
repealing the law and taking away the health care that families already 
have, Republicans are forcing 30 million Americans to lose their 
insurance.
  Republicans are putting the health care coverage of over 200,000 
Wisconsinites at risk, and they are raising taxes on more than 190,000 
Wisconsinites who rely on and receive premium tax credits to help them 
afford high quality health insurance.
  Instead, they are giving tax breaks to big corporations and handing 
over control to the insurance companies, which will be free, once 
again, to deny coverage if you have a preexisting condition, to jack up 
premiums simply because you are a woman, and to drop your coverage if 
you get sick or have a baby.
  I could continue to list some very disturbing facts and statistics of 
what this Republican repeal of health care reform will do to our 
working class and what it will mean to rip away protections from 
families struggling with cancer or other serious illnesses, but these 
facts seem to fall flat on the other side of the aisle. So, instead, I 
am demanding that my Republican colleagues listen--not to me but to the 
calls from the real people who we are here to represent and fight for, 
our constituents back home.
  I demand that they listen to Randy. Randy is from Rhinelander, WI. 
Randy told me that the Affordable Care Act has been a ``savior'' for 
his wife, who was diagnosed with kidney failure more than 2 years ago 
as a result of an autoimmune disease. She has to have dialysis three 
times a week.
  The law eliminated her lifetime maximum limit, and that helps them 
afford her lifesaving care, and it prevents her from being denied 
coverage because of her preexisting condition.
  Randy said that repealing the law will force them to face the harsh 
reality of not only losing insurance but also declaring bankruptcy.
  I also heard from Sheila, from Neenah, WI. Sheila is a small business 
owner who relies on the premium tax credits that helped her purchase 
her health plan through the marketplace. She writes:

       I just wanted to let you know how devastating it will be 
     for my family if the Affordable Care Act is repealed. To take 
     away the subsidies would pretty much turn the plan into the 
     Unaffordable Care Act.

  Sheila has owned a small hair salon for 35 years and said that the 
premium tax credits under the law have made it possible for her to buy 
decent health insurance for the first time in her whole career.
  I want my Republican colleagues to listen to Joel. Joel is a 
physician from Milwaukee. He is on the frontlines of delivering high 
quality health care, and he told me that he had witnessed tremendous 
good that has occurred as a result of the health care law. He has been 
able to provide his patients with better care because they have 
increased coverage. He is especially aware of the positive impact of 
allowing children to stay on their parents' health plans until age 26.
  But Joel remembers the days before the Affordable Care Act. He said 
that he has seen firsthand the insurance companies callously denying or 
dropping coverage for families with preexisting conditions or those 
struggling with a new diagnosis. He doesn't want to go back to the days 
when insurance companies were in charge and literally dictated his 
patients' health.
  I want my Republican colleagues to listen to Chelsea from Shelby, WI. 
When Chelsea was pregnant with her daughter Zoe, she learned that Zoe 
would be born with a congenital heart defect. At just 5 days old, Zoe 
had to have open heart surgery. She had it at Children's Hospital in 
Wauwatosa, WI, and was fighting for her life. Thankfully, she is 
recovering, and she is living a healthy life.
  Chelsea wrote to me:

       The Affordable Care Act protects my daughter, it allows her 
     to have health care access and not be denied. I'm pleading to 
     you as a mother to fight for that and follow through on that 
     promise. There are so many kids in Wisconsin with heart 
     defects (as well as other kids with pre-existing conditions) 
     that are counting on you to protect that right.

  So for Zoe, I want to call on my Republican colleagues to stand with 
me--with all of us--to protect these health care rights and benefits 
for all of our families.
  These are our families who are benefitting right now from the 
protections in the law and the quality, affordable health care options 
it provides. They are calling on Congress, calling on the Republican 
majority to stop their plot that is going to take this all away.
  I could continue to share stories of real Wisconsinites whose 
coverage is at risk today, but I want to take a moment to illustrate 
what life was like before the Affordable Care Act was the law of the 
land, before these sweeping reforms and protections had been put in 
place.
  Now, during my time in the House of Representatives, Sue from Beloit, 
WI, reached out to me. She told me:

       My husband was diagnosed with lung cancer. After treatment 
     began, we found out that the insurance company had a small 
     loophole. Under our insurance, they have a $13,000 limit per 
     year on radiation and chemotherapy.
       That amount did not even cover the first treatment of 
     either radiation or chemo.
       I was not going to have my husband die for lack of 
     treatment, so we started to use our savings and our available 
     credit to pay for medical expenses.
       My husband later died.

  She told me:

       After having completely depleted our savings and facing 
     insurmountable credit card debt, I had no choice but to file 
     bankruptcy. . . .

  Sue's devastating ordeal was a common story all across our country, 
almost 8 years ago, before health care reform was enacted to prohibit 
lifetime caps and to restrict annual limits on care.
  Before the health law, I heard from too many working Wisconsin 
families that went bankrupt, sold their homes, and even spent their 
entire life's savings just to get the health care that they needed. 
This was when America was sick and when lawmakers prioritized the 
health of insurance companies over the health of the American people. 
Republicans will take us back to those days when they vote to make 
America sick again.
  I want to share one last story about life before the Affordable Care 
Act, and that is my own. As many of you may know, I was raised by my 
maternal grandparents in Madison, WI. When I was just 9 years old, I 
was diagnosed with a serious childhood illness similar to spinal 
meningitis, and I spent 3 months at the age of 9 years old in the 
hospital. My grandparents had health insurance but learned that their 
plan didn't cover me. Since their insurance didn't cover me, they made 
incredible sacrifices to pay for the care that I needed. When I got 
better, my grandparents did what any responsible parent or grandparent 
would do: They looked for an insurance policy that would cover me into 
the future, but look as they might, they discovered that because of my 
previous illness, they couldn't find a policy. They couldn't find it 
from any insurer at any price, and at 9 years old I had been branded 
with those magic words: preexisting condition.
  Well, thanks to the Affordable Care Act, children today have new 
protections, and no one can be denied insurance coverage because of a 
preexisting condition. My family experience helped inspire me to enter 
public service and to fight to ensure that every American has quality, 
affordable health care as a right, not a privilege. This is what I 
fought for and will continue to fight with my colleagues to protect, 
these vital benefits that the health care law guarantees to all 
Wisconsinites and families across this great country.
  But we cannot fight alone. Republicans are hard at work making 
America sick again, taking us back from affordable care to chaos, 
handing over the reins to insurance companies and driving up health 
care costs for all Americans. I call on them to stand accountable to 
our families. It is the American people that we are charged to 
represent. I call on them to join us to fight for Sue who was forced 
into

[[Page 451]]

medical bankruptcy. I call on them to fight to protect Zoe from 
predatory insurance companies who want to deny her coverage because of 
her heart condition, to fight for Sheila and other entrepreneurs like 
her, and to fight for our health care professionals, nurse's aides, 
occupational therapists, physical therapists like Joel, and to fight 
for Randy and his wife as they battle her kidney failure.
  We have been ready for over 6 years to work together to keep all that 
works with the Affordable Care Act and to fix what doesn't, but instead 
of working on bipartisan reforms to improve the Affordable Care Act, 
this Republican plan to repeal historic health care reforms will create 
nothing short of chaos. I know I speak for my colleagues, my Democratic 
colleagues and Independent colleagues, in saying that we are here and 
we will stay here on the floor because we are ready. We are ready to 
work across the aisle to protect coverage and to improve the Affordable 
Care Act, but we will not help you make America sick again and we will 
not help you take away people's health care.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Kennedy). The Senator from Oregon.
  Mr. MERKLEY. Mr. President, the Hippocratic Oath that guides health 
care practitioners begins with these powerful words: ``First, do no 
harm.'' This is certainly good guidance for our doctors and other 
health care practitioners, but isn't it good guidance also for those 
who are in the realm of health care policy, for those who are health 
care policy practitioners, as well as the doctors themselves? ``First, 
do no harm.''
  Those powerful first words of the Hippocratic Oath, very relevant to 
this discussion, are being ignored by my colleagues across the aisle, 
by the Republicans who have come to power and said: We are going to 
dismantle health care across this Nation for millions of Americans, and 
we don't know what we are going to do next. We are going to repeal this 
plan, and we are going to run away, and in a few years we might figure 
out how to replace these health care provisions. This is an 
irresponsible perspective. We hold in our hands the health care 
challenges of America, and to repeal and run will do a tremendous 
amount of harm.
  The irresponsibility of it is terrifying families across America. 
They are scared of what the future holds, of the uncertainty that 
awaits them under this strategy of making America sick again. Folks are 
afraid that if they have ever been sick or injured they will soon be 
denied coverage because they have a preexisting condition. They are 
afraid that they may be one of the more than 20 million Americans who 
will lose insurance, having gained insurance and access to affordable 
quality health care through the ACA. They are scared that premium hikes 
will make health care unaffordable to lower and middle-income 
Americans. They are afraid of an unforeseen emergency wiping them out 
financially, driving them into bankruptcy.
  Our seniors are afraid as well. They remember the situation that 
existed before they reached 65 or if they had health care needs and 
didn't have insurance, they had to wrestle between paying for their 
prescriptions or paying their heating bills. They don't want to be in 
that position again. They know how much progress we have made by 
filling the doughnut hole that paid for prescriptions throughout the 
continuum, and they don't want us to go backward.
  From so many different directions, Americans are terrified of the 
Republican repeal-and-run strategy threatening to do harm to their 
lives. How do I know this? I know this because they are writing to me 
and to my colleagues, and we are sharing those stories tonight.
  The letter I have from a young woman in Portland starts out:

       I must implore you to protect the ACA. Its existence saves 
     the lives of millions, including mine. I was born in full 
     renal failure. I currently maintain Stage 3 renal function 
     with the help of prescription medication. If I am unable to 
     afford my medication, I will enter end-stage renal function, 
     i.e., kidney failure. I will die.

  She ended her message by saying:

       I am so scared. . . . I am only 26, I have so much more to 
     do.

  Cameron of Beaver Creek writes:

       My wife and daughter both have chronic health conditions, 
     and the ACA has allowed us to have them covered by health 
     insurance despite having preexisting conditions. If the ACA 
     is repealed, we will lose this protection and I don't know 
     how we could afford to pay for their medical costs directly.

  Lisa in Wilsonville wrote to me about the impact that repealing the 
ACA will have on her special needs daughter. Lisa says: ``If the ACA is 
repealed, we lose funding that directly impacts her programs, her 
respite care, her Medicaid, and I will no longer get support to take 
care of my daughter.''
  Just before Christmas I got a message from Nick in Portland. Nick 
wrote to share his story of a recent medical emergency that threatened 
his life. He said:

       Without notice this past March, my heart suffered a 
     debilitating viral infection which resulted in congestive 
     heart failure. As things stand, I require a new heart, and 
     await that occurrence with patience and resolve. Thanks to 
     the ACA, I was able to purchase health insurance the month 
     prior to that diagnosis. Without it, I don't know how I could 
     have paid for my initial three-week hospitalization. . . . 
     Without it, my ability to obtain a replacement organ would be 
     uncertain. And without it, I envision a bankruptcy filing as 
     the only viable financial option.

  Those individuals are writing about their challenges as patients, but 
doctors are also writing to share their observations as folks who see 
hundreds of patients in the course of a year.
  Meg writes:

       I have practiced both before and after the Affordable Care 
     Act, and witness the sense of hope and relief the expansion 
     of Medicaid in Oregon brought to my patients who are facing 
     serious illnesses. We have been able to participate in 
     community and state level innovations to help transform 
     health care delivery, lowering costs, improving outcomes, and 
     making people's lives better.

  Isn't that what we should be about? Not a strategy of doing harm to 
millions of Americans but a strategy to make these people's lives 
better.
  A physician from Roseburg, a hand surgeon, wrote about the challenges 
that he and his wife face, the serious medical challenges, and says:

       Prior to the Affordable Care Act, we were uninsurable due 
     to these preexisting conditions. It seems clear that the ACA 
     will be repealed, and we, among millions of other Americans, 
     will again be uninsurable. This will not simply be a matter 
     of insurance being expensive; it will be a matter of the 
     insurance not being available at any cost.

  And he continues:

       So I am pleading to you to enact legislation prohibiting 
     insurers from denying the ability to sell policies to 
     individuals with prior medical conditions. The health of 
     millions of Americans rests on your shoulders.

  And I might add that the health of millions of Americans rests on the 
debate and the discussion and the decision of the U.S. Senate.
  Angela, another doctor in Portland, wrote about her work with the 
LGBTQ community, saying:

       The loss of the affordable care act will be devastating to 
     my community. We have only just won the right for patients to 
     access medical care, hormones and surgery in the last year. I 
     have seen a great improvement in my patients' well-being and 
     mental health over the last year with these new privileges. 
     With the loss of the affordable care act many of my patients 
     will be devastated. There is a 50 percent suicide rate in the 
     transgender community already. Please help me prevent any 
     further suicides by protecting the affordable care act.

  There is message after message after message saying ``first, do no 
harm.'' That means we as a body need to come together and move away 
from this reckless repeal-and-run strategy being proposed by the 
Republicans. People are writing to express their fears and frustrations 
and they are calling on us to do the right thing--folks like Meg and 
Nick and Cameron and Lisa and Douglas. Their lives are better because 
we enacted the Affordable Care Act.
  These folks are writing because they are among the millions of people 
who are affected by the changes in this law--the millions who gained 
insurance coverage because of the law or they are among those who 
gained coverage because of the extension of Medicaid or they gained 
coverage because tax credits made health care affordable to lower and 
middle-income families or

[[Page 452]]

they are among the 27 million Americans who live with preexisting 
conditions who couldn't get insurance on the private market or they are 
among those who lost coverage because of annual or lifetime limits 
before the ACA. These stories are powerful because these individuals 
are on the frontline, and health care is essential to their quality of 
life, not just in America but in any location on this globe.
  There is enormous stress connected with a faulty health care system, 
and what we have achieved with the Affordable Care Act is peace of mind 
for millions of Americans--peace of mind that there will be the care in 
place when they need it, that they will be able to afford it and they 
won't be bankrupt, that their loved ones will be able to have their 
health care challenges addressed.
  Folks used to come to my townhalls and say: Senator, I am just trying 
to stay alive till I reach 65 because I have a preexisting condition 
and I can't get medical care. Can you imagine the stress involved with 
that? Folks would say: I would love to get insurance and address the 
health care issues I have, but I can't because I can't afford it. And 
now they can afford it because of the subsidies provided through the 
ACA.
  There was a woman who came up to me at a multiple sclerosis 
fundraising march and she said: Senator, things are so different this 
year.
  I said: What do you mean? What has changed?
  She said: A year ago, in the MS community, if you got a diagnosis and 
you didn't have insurance, you wouldn't be able to get insurance 
because you had a preexisting condition.
  She said: If you did have insurance, it is a mysterious and expensive 
disease, and because of annual limits or lifetime limits, you would 
probably run out of health care. Now we have the peace of mind to know 
our loved ones will get the care they need.
  That is what we are fighting for--to first do no harm and, second, 
make life better for millions of Americans. Let's come together and 
defend these massive advances that we have achieved over the last few 
years and not destroy it with this reckless, irresponsible repeal-and-
run strategy.
  Thank you, Mr. President.
  The PRESIDING OFFICER. The Senator from Delaware.
  Mr. COONS. Mr. President, I rise to join my colleagues in raising the 
alarm about the possible impact for all of us in America and, in 
particular, for my constituents in my home State of Delaware should we 
indeed as a body proceed with barreling forward and repealing the 
Affordable Care Act without a plan to replace it, as seems to be the 
intention of the majority.
  When I was first elected to the Senate back in 2010, the Affordable 
Care Act wasn't even a year old. Yet Republicans were already trying to 
repeal it, without offering any comprehensive plan with which to 
replace it. Now, more than 6 years and 60 repeal attempts later, it is 
truly disheartening to see that when it comes to plans for the American 
health care system, seemingly nothing has changed. Instead of working 
across the aisle to find constructive fixes to this Affordable Care Act 
that could win bipartisan support, instead of finding new ways to 
invest in infrastructure or strengthen American manufacturing or coming 
together to respond to the Russian attack on American democracy or even 
waiting a week to take this upcoming vote so we Senators can give our 
full focus to vetting the President-elect's Cabinet nominees, instead 
of pursuing any of these priorities, it seems we are once again 
spending--even wasting--the American people's time to fulfill a 
misguided and, in my view, mean-spirited promise to repeal the 
Affordable Care Act at all costs, without a clear plan to replace it. 
Sadly, in that sense, nothing has changed since I first came here in 
2010, not so for the American people, as plenty has changed for them 
and for my home State of Delaware.
  More than 20 million Americans now have gained access to high-quality 
health insurance across our whole country, including 38,000 more 
Delawareans. Now, 38,000 is not a big number of people, but in my 
little State of 900,000, 38,000 more people who couldn't get access to 
health insurance before and can now is a big deal. Across the whole 
country, the rate of uninsured Americans is at a record low of just 11 
percent, and in Delaware fewer than 8 percent, and this is well down 
below pre-ACA levels.
  Let me focus on what I think is the biggest, broadest, and most 
important benefit of the Affordable Care Act, not just those tens of 
thousands in my State who have gotten coverage on the exchanges, but in 
my little State of 900,000, 560,000 Delawareans get their health 
insurance through their employer, as the vast majority of Americans do. 
For those half a million or more Delawareans, they have gained lifetime 
improvements to the quality of the health insurance they have through 
the ACA: no discrimination against preexisting conditions, young people 
can stay on their parents' health insurance until they turn 26, free 
preventive care, no lifetime limits on coverage and recovery, and a 
requirement that insurance companies spend 80 cents of every dollar on 
health care versus overhead. These five key consumer protections have 
been the center of the best of what the Affordable Care Act has 
delivered to Delawareans and Americans. Americans no longer have to 
make the phone calls they used to make to their Senators, their 
Congressmen, their local representatives, pleading that they could 
somehow find access to quality and affordable coverage. These reforms 
have made a real and tangible impact on Americans across the country.
  I have also come to this floor, on a number of occasions over many 
years, and recognized the challenges of the Affordable Care Act, the 
ways in my home State that it has fallen short of our hopes and goals 
when it was initially passed, and I have offered, with an open hand, to 
work across the aisle to find vehicles to repair and improve elements 
of it that haven't worked as had been hoped.
  Before I turn to that, though, let us focus for a few minutes on 
hearing the stories of Delawareans who have reached out to me because 
at the end of the day, my passionate defense of the Affordable Care Act 
is rooted in individuals I have met and heard from, people whose lives 
have been changed by access to quality, affordable, accessible health 
care.
  As Republicans move us forward to a repeal vote, it is my hope that 
they will listen to these and other stories and think about what 
possible alternative pathway there might be that would save the 
opportunity for them to have access to decent, quality health care.
  I grew up in this tiny town of about 1,500 called Hockessin, DE, and 
Nicole is also from Hockessin. She reached out to me to tell me her 2-
year-old daughter has cystic fibrosis. She spends at least an hour 
every day administering her daughter's breathing treatments and at 
least $5,000 a month. Her medications aren't cheap. Nicole is confident 
that without the Affordable Care Act, she would have exceeded her 
annual cap on medical expenses well before the end of each year.
  Nicole makes it pretty clear to me that without the consumer 
protections put in place by so-called ObamaCare--the ACA--she would 
have one of three choices, choices tragically faced by many Delawareans 
and Americans before the Affordable Care Act. One, hope she somehow 
qualifies for Medicaid, which she probably doesn't because she is hard-
working enough and successful enough that her income makes her 
ineligible for Medicaid. Option No. 2, go into deep debt to pay for her 
daughter's needed and lifesaving treatment. Option No. 3, stop giving 
her daughter some of the medication she depends on and just hope and 
pray that she will not suffer needlessly. That is all assuming that her 
daughter's cystic fibrosis was not a preexisting condition, preventing 
her from getting any insurance at all.
  Let me review that because Nicole's story starkly outlines the 
reality that millions of Americans could face if we continue barreling 
down this misguided path of repealing the Affordable Care Act wholesale 
without coming together

[[Page 453]]

around a plan for replacement. That reality for so many sick Americans 
or Americans with sick children is this: First, hope you don't get 
sick. If that fails and you don't qualify for some other form of 
government assistance, either go into debt or try to get by without 
health care. That is it. That is what it was before the Affordable Care 
Act, and following its repeal, that may sadly be what it is again.
  Over the last few weeks, I have heard many other stories, and I will 
cover a few quickly, if I may. Kim, from Wilmington, DE, is a thyroid 
cancer survivor who was able to get insurance because her cancer is no 
longer considered a preexisting condition. Will her ability to access 
affordable, quality health care be repealed?
  There is Sue from Frankford, DE, whose husband got sick a decade 
ago--desperately sick--and hasn't been able to work since. They are 
retired but not quite eligible for Medicare. Yet, despite his illness, 
they have been able to find coverage now on the individual market. Will 
repeal of the Affordable Care Act deny Sue and her husband access to 
quality health insurance?
  There is Carla from Odessa, DE, whose son was able to stay on her 
health insurance when his employer didn't cover it. Not only that, but 
Carla's sister--a self-employed gardener with a 40-year history of 
insulin-dependent diabetes, also known as a preexisting condition, was 
able to get health insurance when she tragically divorced at age 63 and 
lost coverage through her husband's employer.
  There is Matthew from Wilmington, whose son was diagnosed with brain 
cancer. The year before his son's diagnosis, Matthew and his family 
were on a non-ACA-compliant health insurance plan. As Matthew wrote me, 
``Our family was all young and healthy, and we thought this plan was 
right for us. Then, my 11-year-old got sick right out of the blue. It 
can happen to anyone at any time.''
  Matthew is right. Illness can strike any one of us at any time--and 
not just the flu, not just a cold, but tragic, expensive, terminal 
illnesses can strike any family in America at any time.
  Just listen to the story of Kerry from Wilmington, DE, a massage 
therapist who considers the Affordable Care Act, as she puts it, 
``nothing short of miraculous.'' Here is why. Kerry signed up for 
health insurance in 2014 thanks to the subsidies, the tax credits 
provided through the Affordable Care Act. She had long had nagging 
abdominal and lower back pain. She didn't think much of it considering 
she had no family history of terrible diseases and had never even had a 
stitch before. Fast forward to January of 2015, when a routine 
diagnostic procedure covered by her new health insurance revealed that 
Kerry had stage III colon cancer. She had surgery a week later, 
followed by 6 months of chemotherapy, and ended up facing no out-of-
pocket expenses besides her annual deductible. Kerry's cancer has now 
been in remission since September of 2015, and as she writes, ``The ACA 
came along at the last possible moment to save my life. I am certain 
that without it, I would have just continued to live and work with the 
discomfort and try to self-treat until the cancer was so advanced it 
could not have been successfully treated.''
  I have many more, but stories like Kerry's and Matthew's and Carla's 
and Sue's and Kim's have been pouring into the inboxes of my colleagues 
in States around the country.
  My Democratic colleagues and I know, and have known since the day it 
was signed into law, that the ACA is not perfect. I have talked to 
small businesses that want to offer health insurance for their 
employees but have struggled to find affordable options in Delaware. I 
have met plenty of Delawareans whose deductibles or premiums are higher 
than they would like to see, and I have heard from economists and 
budget forecasters who know our country's fiscal health depends on 
doing even more to control health care costs.
  That is exactly why 2 years ago I came to this floor with a simple, 
commonsense request of my Republican colleagues: work with us to make 
the Affordable Care Act better. A colleague, a physician from the State 
of Louisiana, happened to be listening that day, and we have had a 
number of constructive and positive conversations since. Sadly, despite 
many attempts over many years, I so far have been unable to find a 
Republican partner willing to actually cosponsor meaningful, 
constructive fixes to the law.
  In my view, and as I said 2 years ago, no conversation about the 
Affordable Care Act and how to improve it can be complete without 
reconciling the reality of the millions of Americans it has helped and 
the many others for whom it has fallen short.
  I have sought to address the affordability of health care coverage 
for all families. I have cosponsored bills to increase tax credits to 
make it more affordable for small businesses, looked for ways to make 
sure there is more competition in the marketplace, especially in small 
States like Delaware, and pursued commonsense regulatory reforms and 
cost-containment efforts to further slow the growth in health care 
costs. For years, my colleagues and I have asked our Republican friends 
to put aside their rhetoric and focus on pursuing bipartisan fixes like 
these.
  Today, the bottom line is still this: I know the Affordable Care Act 
has helped millions of Americans just like the Delawareans whose 
stories I have read. Kerry, Carla, Matthew, Sue, and Kim today live 
healthier, safer, and more secure lives.
  Let's take a look at the alternative. There is no single proposed 
plan. There are dozens of bills in the House and Senate that would do 
lots of different things, but it would be very hard to predict with 
precision what the alternative really is. We know what repeal will do. 
As of today, the alternative--let's call it TrumpCare--is nothing more 
than a wholesale repeal with no clear plan to replace.
  TrumpCare, a simple repeal, by one estimate would kick 26 million 
Americans--more than 50,000 Delawareans--off their health insurance. 
Even for those who don't lose their insurance, those hundreds of 
thousands of Delawareans who get their insurance through their 
employer, it would be much lower quality because it would remove all 
the consumer protections that we have all come to embrace. It would 
give a nearly $350 billion tax cut to the wealthiest 1 percent of our 
country and a nearly $250 billion tax cut to big corporations. While 
tax cuts have their day and their reason, pushing aside all of that 
revenue with no plan for how to replace the Affordable Care Act and how 
to pay for it will become a desperate and dangerous move. TrumpCare, a 
simple repeal of the Affordable Care Act, would cut 3 million jobs and 
trigger negative economic impacts well beyond the health care sector by 
creating profound uncertainty. Lastly, it would burden State and local 
governments, which would lose nearly $50 billion in tax revenue.
  That is the reality. Describing a repeal of the Affordable Care Act 
as anything other than the injection of wild uncertainty into our daily 
lives, into the health insurance and health care markets is just not 
square. That is the reality. Describing it any other way is political 
rhetoric, and that is, sadly, what this debate is about. It is repeal 
without replace.
  Matthew from Wilmington, whose 11-year-old son was diagnosed 
unexpectedly with brain cancer, concluded his note to me with one last 
thought. He wrote of his son: ``He's my hero and I will fight for him 
and all others who continue to suffer similarly every day.''
  Thank you, Matthew. Thank you for sharing your story and continuing 
the fight. I promise you and all the Delawareans who have reached out 
to me to do my level best to stand with you and fight for you every 
step of the way every day until we find a better path together.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Maine.
  Mr. KING. Mr. President, my colleagues have spoken tonight eloquently 
about a number of consequences that would follow from the repeal of the 
Affordable Care Act: increasing drug

[[Page 454]]

costs for seniors, a devastating impact on rural hospitals, elimination 
of consumer protection in everybody's health insurance--not just those 
on the Affordable Care Act--and limitations on mental health coverage 
and substance abuse. All of those issues have been presented eloquently 
and passionately.
  I want to do something a little different. This isn't easy for me, 
but I want to tell my own story and why I feel so strongly about the 
issue of health insurance for all of our people.
  Forty-three years ago--I think it was just about this week--I was a 
young staff member here in the Senate. I was a junior staff member who 
was covered by health insurance provided by my employer, the U.S. 
Senate. I paid a share, and the Senate paid a share. The health 
insurance that I had, as part of it, had free preventive care--exactly 
like that required by the Affordable Care Act.
  The other thing the plan I chose had was a Wednesday night doctor's 
session. So because I had a free checkup and because it was on 
Wednesday night and I didn't have to miss any work, in late January or 
early February of 1974, I went in for a checkup--the first one I had 
had in 8 or 9 years. Everything looked fine. As I was putting my shirt 
back on, the doctor said: Well, you have a mole on your back, Angus, 
and I think you ought to keep an eye on it.
  That night, I went home and mentioned it to my wife. The next 
morning, she said: I don't like the looks of that thing. Let's have it 
taken off.
  I went back in the following Wednesday night because they had 
Wednesday night hours and I didn't have to take off from work. I had 
coverage so I didn't have to worry about what it was going to cost me, 
and the mole was removed. When they called me to come back in--I will 
never forget this moment as long as I live--the doctor said: Angus, I 
think you had better sit down. He told me that I had what was called 
malignant melanoma.
  At the time, I didn't know what it meant. I thought it was simply a 
skin cancer. You hear about those all the time. You have them taken 
off, and it is no big deal. No, malignant melanoma is one of the most 
virulent forms of cancer. One of its characteristics is that it starts 
with a mole, but if you don't treat it, it then gets into your system 
and goes somewhere else. If you don't catch it in time, you will die.
  I caught it in time. I had surgery. They took out a big hunk of my 
back in surgery and up under my arm. To this day, my shoulder is still 
numb from that surgery, but here I am.
  It has haunted me since that day that I was treated and my life saved 
because I had health insurance. I know to a certainty that had I not 
had that coverage, had I not had that free checkup, I would not be here 
today. It has always stayed with me that somewhere in America that 
week, that month, that year, there was a young man or a young woman who 
had a mole on their arm or their back or their neck, couldn't do 
anything about it, didn't really think about it, didn't do anything 
about it until it was too late, and they are gone. And I am here. I 
don't know why I was saved. Maybe I was saved in order to be here 
tonight. But for the life of me, I cannot figure out why anyone would 
want to take health insurance away from millions of people. It is a 
death sentence for some significant percentage of those people.
  In 2009, the American Journal of Public Health did a study--a 
comprehensive study. What they concluded was that for every million 
people who are uninsured, you can predict about 1,000 premature 
unnecessary deaths. So the math is pretty simple. Right now, we are 
talking about over 20 million people who have been afforded health 
insurance, either through the exchanges or through the expansion of 
Medicaid, who didn't have it before. If we take that away, that is 
22,000 deaths a year. How can we do that with good conscience? How can 
we sentence people to death? We are talking about bankruptcies. We are 
talking about all the kinds of stories we have heard. They are all 
valid. They are all important. But for me, this is personal. This is 
about life itself. It is about our ethics, our morality, and our 
obligation to our fellow citizens.
  Like all the other speakers, I know there are lots of problems with 
the Affordable Care Act. I wasn't here when it passed. It isn't exactly 
the way I would have worked on it or written it. I am ready to sit down 
with anybody who wants to talk about finding a solution, but let's not 
talk about the solution being ripping coverage away from people who 
desperately need it. It is just wrong.
  I understand the political impulse. Folks on the other side of the 
aisle have been talking about this for 6 years, and, by golly, they are 
going to repeal it and get rid of it, and people cheer and all of that 
kind of thing. But now it is real. This isn't rhetoric anymore. This 
isn't a bumper sticker anymore. This isn't a rally anymore. This is 
real people's lives.
  So let's just slow down. If people want to come up with a different 
solution, if they want to modify the current system, if they want to 
try to make changes that make it easier for small businesses and change 
the hours of work and the definition of full time--all of those things 
can be discussed. I don't care who leads it. I don't care whether we 
call it TrumpCare, McConnellCare, or RyanCare. We can call it whatever 
we want, but the fundamental principle here is that health insurance is 
a life or death matter, and we should honor the commitment that has 
been made to those millions of people--including over 80,000 people in 
Maine--who have taken advantage of this program, many of whom have 
never had health care before, many of whom have had tragic stories that 
we have heard all night about children born with birth defects or 
children that had some disease at a young age or an adult who, as we 
just heard a few minutes ago, finds they had cancer and if they hadn't 
had the coverage and gone in, they wouldn't be here.
  This isn't politics. This is people's lives. I can't believe that the 
good people that I know in this body on both sides of the aisle can't 
figure out a way to say: Let's slow down. Let's slow down and talk 
about how to fix it, how to change it, how to replace it. But put that 
before repeal because once repeal occurs, there are all kinds of bad 
results, even if they are grandfathered.
  People say we are going to repeal and delay. That is repeal and 
chaos. The insurance industry is going to start to pull back. The 
health care industry is going to say: Well, we don't know what the 
situation is going to be. We are going to have to slow down. We are 
going to stop hiring. We are going to lay people off.
  All those changes are going to start happening right away. They can't 
be prevented. To tell people don't worry, we are going to cover you--
that is cruel. I don't think my colleagues intend to be cruel. There is 
not a mean-spirited person in this body. We just have a different view 
of how to achieve these results. But the fundamental results should be 
people have health insurance so they don't have to risk their lives 
every day and live under that threat. That is what this discussion is 
all about. That is why I am here.
  I view this as much more than a political issue. I understand the 
differences, I understand the history, and I understand the politics of 
it, but I just think that now that it is real, let's slow down and find 
another way to solve this problem that protects the gains that have 
been made and sands off the rough edges of the law but allows us to 
protect the fundamental idea of helping people to find health insurance 
they can afford and keep them from being denied health insurance for 
reasons through no fault of their own.
  I think this is a moral and ethical issue, and I go back and I feel 
so strongly about this because of my own experience. I feel I owe it to 
that young man in 1974 who didn't have insurance, who didn't have the 
checkup, who had melanoma, and who died. I have an obligation to that 
young man to see that doesn't continue to happen in the wealthiest, 
most developed society on Earth.
  This is something we have within our power to do. I deeply hope that 
we can take a deep breath, back away from this idea that we have to 
repeal, and

[[Page 455]]

talk about fundamental principles of helping people to cope with this 
most serious and personal of issues.
  I have confidence in this body. I have confidence in the good will of 
this body and of the American people. If we can get away from talking 
about it in the abstract as a political issue, we can talk about real 
people. That is what I hope we can do over the next weeks and months, 
and I am convinced we can come to a solution--not that will make 
everybody happy but that will save lives and make our country a better 
place.
  I yield the floor.
  The PRESIDING OFFICER. The Democratic leader.
  Mr. SCHUMER. Mr. President, first, let me thank my good friend from 
Maine for his usual eloquent remarks.
  I thank my colleague from Connecticut, who is one of our great 
speakers and mainstays, who has let me sneak in ahead of him. So I will 
be brief.
  My Democratic colleagues are holding the floor tonight to demonstrate 
our solidarity and our commitment to defending the Affordable Care Act. 
It is not just defending some abstract law. It is not about protecting 
President Obama's legacy or Democrats' legacy. It is about people. It 
is about the American people and their access to affordable health 
care. It is about defending a health care system that has been made 
fairer, more generous, more accessible, and more affordable for the 
American family. It is about men and women and children whose stories 
we have heard tonight from Member after Member, one part of the country 
to the other, and their lives have been changed. In many cases, their 
lives have been saved by health care reform.
  That is why Democrats have held the floor tonight. Though the hours 
have waned on, we will fight this repeal with every fiber of our being. 
We will not go gently into that good night.
  The history of health care reform has been cast and recast by both 
parties, but there is a truth to be told amidst a lot of fiction. Here 
is a truth. Before the Affordable Care Act, our health care system was 
a mess. Health care costs were growing at a rate much faster than they 
are today, eating into workers' paychecks, dissuading them from taking 
risks and changing jobs lest they lose good coverage. A debilitating 
illness could wipe away a lifetime of hard-earned savings because 
insurers could put limits on how much treatment they would cover. Women 
were charged more for the same health care coverage. Many couldn't get 
insurance if they had a preexisting condition. Some insurance companies 
would simply delete you from the rolls if you got sick; in short, 
premiums spiraling up, spotty coverage, discriminatory practices, a 
marketplace out of balance. I remember the days before health care 
reform, before ACA. Everyone was complaining about the system. This 
idea that everything was hunky-dory and then ACA came in is fiction.
  I was involved. We knew health care reform would be difficult. It is 
a $3 trillion industry with complicated rules and procedures. The 
politics were arduous. For that reason, health care reform had 
bedeviled Congresses and Presidents for decades. We knew in 2009 that 
we had a rare opportunity and that it was too important to let politics 
or lobbyists or special interests or fear stand in the way.
  In the past, Democrats were able to make progress on smaller slices 
of the overall pie. The CHIP program, my dear friend who is no longer 
here, Senator Jay Rockefeller, championed it. Getting generic 
prescription drugs on the market, I was involved in that, along with 
the Senator from Utah. Never, never was a Congress able to pass a 
comprehensive package of reforms to the health care system until the 
ACA--the greatest leap forward in American health care, certainly since 
the passage of Medicare and Medicaid.
  You can measure the results. The law has helped bend the health care 
costs curve down, insured more Americans than any time in our Nation's 
history since we started measuring the uninsured rate, all while 
providing higher quality health care.
  Is the act perfect? No, no one ever said it was. I have listened to 
my friend the majority leader and our Republican colleagues on the 
floor these past few weeks. They used quotes from President Obama 
saying the law could use improvements as proof that it is failing.
  That doesn't hold up. Go look at the full quotes. No one ever said 
the law would be perfect. We all know it could use some fixes. I, for 
one, am for a public option--we nearly had it in 2009--to increase 
competition in marketplaces where there is still too little. But scrap 
the whole thing and go back, back to a chaotic marketplace, 
inconsistent coverage, skyrocketing premiums? No way. Back to 40 
million uninsured Americans, back to discriminating against women and 
Americans with preexisting conditions? No way.
  Democrats don't want to make America sick again. We don't want to 
repeal the largest expansion of Affordable Health Care since Medicare 
and Medicaid and leave chaos in its wake--chaos instead of affordable 
care. That is what the Republican plan would do, sure as I am here 
tonight.
  This evening, as colleague after colleague has come to the floor to 
describe how the ACA is helping their constituents, helping nurses, 
helping rural hospitals, helping students, helping seniors, I hope my 
Republican friends may have listened to them. The American people 
certainly are. They have been watching this debate. We have been 
talking to them on the phones, and they will carefully consider the 
consequences of repealing this law, and I hope our Republican 
colleagues will--particularly without a viable comprehensive 
replacement.
  With the close of this long night, I make a simple plea to my 
Republican colleagues: Turn back. It is not too late. You are already 
hearing the grumblings from Members on the left side of your caucus and 
the right side of your caucus.
  Well, they are starting to say, now that you have some power here, 
you are in the majority, maybe we shouldn't repeal without replace, 
even though for 6 years you have been unable to come up with a 
replacement.
  The Republican Senators from Maine, Arkansas, Tennessee, and 
Kentucky, former Senator Rick Santorum, even the President-elect says 
that maybe we should replace and figure out how to replace before we 
repeal, but with this vote, it would just repeal it.
  My simple advice to my Republican colleagues is turn back. The health 
care of Americans hang in the balance. Affordable care for every 
American hangs in the balance. If Republicans repeal the ACA without a 
detailed comprehensive plan to replace it, not a mere framework, not a 
set of principles, not a bunch of small-ball policies cobbled together, 
they will create utter chaos, not affordable care.
  It is not too late. Work with us Democrats. If you tell us tomorrow 
you are giving up on repeal, we will work with you to improve it. We 
know there needs to be some improvements, but don't scrap the law, 
leaving all those in the lurch and then come to us and say: Now let's 
fix it.
  You better have a replacement. Something you haven't been able to do 
for 6 years. It is not too late. Work with us Democrats on improving 
the law. Work with us on making it better. Don't scrap it and make 
America sick again. Turn back before it is too late. It will damage 
your party. It will hurt millions of Americans, far more importantly, 
and hurt our great country.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Connecticut.
  Mr. MURPHY. Mr. President, once again, congratulations on your 
election. I haven't gotten a chance to talk with the Presiding Officer 
in detail about his path to the U.S. Senate, but I have had a chance to 
talk to a lot of my colleagues about how they got here, and I think we 
can all agree it is not often a real pleasant experience. You get your 
name dragged through the mud. You get called all sorts of names. You 
have to call lots of friends and strangers and ask them for money. It 
is no walk in the park to run for political office or to put your name 
out there and be the subject of both praise and a lot of ridicule.

[[Page 456]]

  It is not surprising the reason that people do this. The reason that 
the 100 of us have decided to run for office and to put ourselves out 
there in the public spotlight is because we deeply care about our 
neighbors, about the people who live in our States. We are doing this 
job, to a man and woman, because we want to make life better for 
people; in particular, people who have been just thrown big curveballs 
by life.
  I grew up in a pretty economically secure house, but I understand a 
lot of kids don't have that opportunity, and I feel like both 
Republicans and Democrats are here because we want to lift those kids 
up. I have had a pretty healthy life, a few bumps and bruises along the 
way, but I feel like both Republicans and Democrats are here because we 
get that other people aren't as fortunate. They got sick. They got 
diagnosed with something terrible. Our role should be to try to help 
get them some cures or some treatments.
  We are here not because we think it is fun to run elections, we are 
not here because we like the look of our name on the door, we are here 
because we care desperately about people. I think this is what Senator 
King was getting at in his remarks. All of the tabloids and the TV news 
shows, they spend 80 percent of their time focusing on politics, and we 
end up chasing our tail off in here because if the daily political rags 
and the cable news shows are talking about politics, then maybe we 
should be talking and thinking about politics as well, but that is not 
why we decided to do this. We decided to run for the Senate because we 
care about people.
  Why we are here tonight is pretty simple. Ultimately, the repeal of 
the Affordable Care Act, with no replacement, with no plan for what 
comes next, will hurt millions of real people in very real ways. In the 
end, I don't believe that my Republican colleagues want to cast a vote 
that will do that.
  This tall guy right here is Josh Scussell. He lives in Connecticut. 
He is from Guilford. He is standing next to his bone marrow donor and 
her boyfriend. This is Josh's wife. Josh was diagnosed with stage IV 
non-Hodgkin's lymphoma in 2012.
  Here is what Josh says. He will tell you the unvarnished truth. Josh 
says: ``The ACA is entirely responsible for me still being alive.''
  He relapsed after an additional diagnosis before he turned 26, and 
the only way he was able to get insurance was because of the Affordable 
Care Act, which allowed him to stay on his mother's insurance up until 
he turned 26. During the course of his treatments, he underwent stem 
cell transplants, which could be up to $200,000 each. Because of those 
transplants, he needed ongoing weekly treatments at a cost of $10,000 
per treatment.
  He recalled how he was getting his first stem cell transplant and he 
was in the hospital during the Supreme Court deliberations on the 
Affordable Care Act. He said, ``I was in a hospital bed watching the 
TV, when the Supreme Court approved the ACA, and just the feeling I had 
in my body was a feeling that I had never experienced before because I 
knew that I was going to be taken care of.''
  Josh is in remission. In a few more years of being cancer-free, the 
doctors tell him he might be out of the woods. He says, ``I'm more 
fearful for other people in my position. . . . Because there's no way I 
would have been able to afford any of those treatments'' if it wasn't 
for the Affordable Care Act.
  This little guy, his name is Rylan. This is his mother Isabelle. 
Rylan was born with a congenital heart defect. One day he had to be 
rushed to Connecticut Children's Medical Center for emergency open-
heart surgery to keep him alive. Isabelle says that she never really 
thought about health insurance. She knew she had it, but she didn't 
really think about it until Rylan went for that emergency surgery. She 
thought: Oh, no, is our insurance going to cover it? Will they cover 
all the treatments he needs going forward now that he will have had a 
preexisting condition? She found out that the Affordable Care Act 
protected her because it eliminated a common practice of insurance 
companies to cap the amount of coverage you get in any one given year 
or over the course of your lifetime.
  Isabelle tells it plainly. She says:

       Without the Affordable Care Act, we would have never been 
     able to afford the care for Rylan. We would have had to make 
     awful decisions--decisions about whether we kept our house, 
     kept our car, whether we could still afford to work.

  It was the Affordable Care Act that protected her and her family.
  Finally, this is John. John is a hero in my book. John was born with 
cystic fibrosis. John tells the story about how health care is the most 
important thing to him in the world. It is more important than salary. 
It is more important than his job. It is more important than friends. 
He struggles every day to live. The only way he lives is that he is 
able to take medications that allow him to continue to breathe and that 
allow his lungs to continue to function amidst this crippling disease 
and diagnosis.
  John is on the Affordable Care Act, and John will tell you, just as 
plainly as Josh and Isabelle, that without the Affordable Care Act, he 
would die--not 2 years from now, not 3 years from now. John would die 
within a matter of weeks because without his medications, he cannot 
live.
  It is not hyperbole to suggest that the absence of the Affordable 
Care Act is a matter of life and death. John will tell you that without 
the Affordable Care Act, he doesn't have insurance. Without insurance, 
he cannot afford the medications to keep him alive. Without the 
medications to keep him alive, John disappears from this Earth.
  These are real people. I care about them because I know them, and I 
have had the chance to meet John and Isabelle and Josh. But you have 
these people in your State as well. My Republican colleagues have just 
as many of them. Some of the biggest numbers of enrollment in the 
Affordable Care Act aren't in States represented by Democrats; they are 
in States represented by Republicans. And this mythology that the 
Affordable Care Act hasn't worked or that it is in some death spiral is 
just political rhetoric. It is not true.
  This is an AP fact check story from today, I believe. Here is the 
beginning of it. It says:

       President-elect Donald Trump says that President Barack 
     Obama's health care law ``will fall of its own weight.''
       House speaker Paul Ryan says the law is ``in what the 
     actuaries call a death spiral.''
       And Senate Majority Leader Mitch McConnell says that ``by 
     nearly any measure, ObamaCare has failed.''

  The AP says:

       The problem with all these claims: They are exaggerated, if 
     not downright false.
  The Affordable Care Act has not failed for the 20 million Americans 
who have insurance now because of it. The Affordable Care Act has not 
failed for the millions more who are paying less because insurance 
companies can no longer discriminate against them if they have a 
preexisting condition. The Affordable Care Act has not failed for 
seniors all across this country who are on Medicare and are paying less 
for prescription drugs.
  There is no doubt that the Affordable Care Act isn't perfect. 
Medicare wasn't perfect when it was passed. We amended it 18 different 
times. The Affordable Care Act needs to be amended and perfected, as 
well, but if you really care about people instead of political 
headlines, then the prescription here is simple: Stop. Take a step 
back. Don't lurch the entire health care economy into chaos when you 
don't have to.
  I am pretty sure that Donald Trump is going to be President for the 
next 2 years. I am pretty sure that Republicans are going to control 
the Senate and the House of Representatives for the next 24 months. You 
have time. You don't need to prove some point to the political talk 
show hosts and the conservative radio commentators. You can step back 
and rescue these real people from the fate that you are about to 
subject them to by--instead of engaging in a partisan repeal with no 
replacement for what comes next--reaching out across the aisle and 
working with Democrats to try to fix this law.
  I have been here the last 6 years. I was part of the passage of this 
law when I was in the House of Representatives. I have listened to my 
colleagues say, literally tens of thousands of times in Washington and 
across the

[[Page 457]]

country, that their priority was to repeal and replace this law. I 
watched on TV our President-elect say in response to a question about 
the process for health care repeal going forward:

       No, we are going to do it simultaneously [repeal and 
     replace the law]. It'll be just fine. We are not going to 
     have, like, a two-day period and we are not going to have a 
     two-year period where there is nothing. It will be repealed 
     and replaced.

  There will not be a 2-day period in between repeal and replace. And 
that is what I heard from my Republican colleagues: Put your vote where 
your mouth has been because the alternative is a death spiral.
  The Associated Press calls the mistruths out and says: No, the 
Affordable Care Act is not in a death spiral. But those same health 
care economists who are quoted in that story will tell you that if you 
repeal this bill without any replacement for what happens next, that is 
what creates the death spiral. Why? Because when you put a clock 
ticking on the life of the Affordable Care Act, then a couple of things 
happen. First, people who need some procedure done rush into those 
exchanges and they drive up the actuarial cost, and insurers just look 
at themselves and say: Why would you hang around for that? And they 
bolt. So the Affordable Care Act falls apart if you telegraph to people 
that you have only 1 year or 2 years left.
  You don't have to do this. You don't have to visit that kind of harm 
on real people. I know that is not why Republicans ran for office. I 
know we have philosophical differences on how to get health care to 
people, about how to insure more people, but let us sit down and figure 
out a middle ground so we can save the lives of all these people who 
are relying on us.
  What we are doing right now is extraordinary. This is absolutely 
extraordinary. We were sworn in less than a week ago. The new President 
has not even been inaugurated. There isn't even a conceptual plan for 
what will replace the Affordable Care Act, and we are rushing forward 
with repeal. There is an enthusiasm to this cruelty that is hard to 
understand.
  I hope that some of the Republicans who just in the last 24 hours 
have called for a delay in this debate are heard by Republican 
leadership. I know that Democrats will continue to be on this floor to 
make this case. I guess I am still optimistic enough about what is 
still a pretty broken town that, in the end, my Republican friends 
aren't so cold-hearted, aren't so barbaric as to take away insurance 
from people like those we have been talking about here today when there 
is an alternative, when there is another way, when there is no 
political imperative to do this kind of damage to people right now.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Hawaii.
  Mr. SCHATZ. Mr. President, I want to thank the junior Senator from 
Connecticut for his leadership on ACA. Since we arrived in the Senate 
together, he has been stalwart, not just on the many benefits of ACA 
but specifically on mental health and the benefits and the 
destigmatization of mental health care in the context of ACA.
  It wasn't so long ago that people wouldn't step up and say: I need 
help. I need mental health care. But now I think it is broadly accepted 
on both sides of the aisle, partly because of Chris Murphy's 
leadership, that mental health is health and that just as if you tweak 
your shoulder or need something with your lungs or have a crick in your 
neck, if you have some mental health issues, you need to get them taken 
care of.
  The plan to repeal the Affordable Care Act with no replacement 
reminds me of a car I used to have. It was an OK car. I remember I 
bought it in 2006. It was a 2005, but it was new--one of those in the 
back of the lot. I got it for $2,500 less than MSRP. It was a station 
wagon. It was ugly. It was purple, and I just sort of rode it into the 
ground. I kept driving it. I didn't take great care of it. I have 
gotten better about taking care of my cars. At the time I just rode it 
and rode it. The AC busted, and I didn't fix it. There was a fender 
bender, and I didn't fix that. The car was OK. It needed some TLC, but 
it got me around. What if I had taken this car to Jiffy Lube in 
Honolulu just to get a little tuneup and left it, and then I came back 
an hour later and it had been dismantled? That is what the Republicans 
are doing with the Affordable Care Act. Instead of fixing what is wrong 
and keeping what is working, they are going to destroy the American 
health care system.
  I try very hard not to be too apocryphal with my language. I try very 
hard not to be too nasty and too partisan on this floor, but this is 
factual. They are going to destroy the American health care system. 
That is what repeal and replace is all about. They are going to remove 
a law from the books and come up with something terrific in a few 
months or a few years, but they are also going to keep the stuff you 
like.
  Here is the first thing that everybody across the country needs to 
know about this process. It is not on the level. There is no way around 
it. This is just not on the level. Anybody who has spent any time 
thinking about health care policy knows that covering people with 
preexisting conditions like cancer, mental illness, and diabetes is a 
popular thing to do. It is the right thing to do. People also know that 
the only way to do that is to create a risk pool that includes healthy 
people. If you are going to insure folks, you can't just be paying out 
for the expensive cases; you also have to be bringing in revenue and 
not paying out, so you need young people in the risk pool. You need 
professionals in the risk pool. You need nonsick people in the risk 
pool. That is how this all works. Everybody understands that.
  Everybody who is working on this in good faith understands that you 
need to create a risk pool in order to cover more people. So they know 
that if they eliminate the individual mandate, they eliminate the 
benefit, but they are stuck with a promise they made to repeal this law 
totally, root and branch--not to improve upon the law.
  Just remember that it was an article of faith that we couldn't make 
even the most modest improvements to this law at any point in the last 
6 or 7 years; that if you did so, you ran afoul of Republican 
orthodoxy. It is not that they wanted to fix the law. It is that they 
had told everybody it was so bad--partly because it was ObamaCare--that 
there was nothing good in it; there was nothing worth preserving about 
the Affordable Care Act.
  Now they are into repeal and replace. They are stuck with the promise 
they made to repeal this law totally, and they know people are about to 
be very, very angry because President Obama is the President only for 
another 10 days, and people are not going to accept the premise that we 
are going to rip health care out from under you, but don't you hate 
health care because it is called ObamaCare? That is an argument that 
may have worked 3, 4, or 5 years ago, but with a new President-elect 
and a new Congress, we have an obligation to have a better strategy 
than that.
  Republicans do not have a replacement plan. If they had one, they 
would be adopting it shortly. It has been 7 years. It has been 7 years, 
and we haven't seen any legislative language--none. They have no plan 
at all for American health care other than to cause immediate harm and 
to try to blame it on the law that they are repealing.
  There are only a few ways this could end up. I will give you a couple 
of them. First there could be the equivalent of a health care cliff, 
which is similar to what we have done with our fiscal situation where 
they have to periodically shovel money at the problem and bail out the 
insurance companies. What will happen is they are basically 
eviscerating the revenue that provides the subsidies for individuals, 
but they are going to realize: Hey, these subsidies are quite popular, 
but we just eliminated the revenue. We don't want to increase taxes so 
let's borrow money and keep shoveling money at the insurance companies 
or they may make minor reforms in the ACA and call it a replacement. 
That would be great. I do not see that they are on this path right now 
or they are really going to repeal the law and take health care 
coverage away from millions of Americans. This is completely 
irresponsible.

[[Page 458]]

  So what happens when they repeal ACA? Twenty-two million people will 
have their health care coverage ripped away from them, more than 22 
million men, women, and children. For those of you who still have 
coverage, I want you to know that this impacts you too. If you have a 
preexisting condition as common as diabetes or high blood pressure or 
mental health issues or cancer or Crohn's disease or Lupus or in a lot 
of instances pregnancy is a preexisting condition, you are not going to 
be able to keep your coverage.
  If you are a woman, you are likely going to lose access to preventive 
health care services like birth control. If you live in a rural area--
everybody in rural America should understand this.
  There is this thought that there are rural States and nonrural 
States. Every State is both a rural State and a nonrural State. I know 
the Presiding Officer has an urban area and plenty of rural areas. I 
have one of the densest cities in the United States, and then I have 
far-flung, very small towns that are old plantations. Everybody in the 
Senate represents rural America in some form or fashion.
  If you live in a rural area, chances are that your local hospital 
will lose millions of dollars in funding, which will force many rural 
hospitals to turn away patients and close their doors. This is not an 
exaggeration. I encourage every Republican Member of the Senate, Member 
of the House, citizen out there to ask their health care leaders in 
rural hospitals what is about to happen. They are in a panic.
  Let's be totally clear about what this means. You lose rural hospital 
money and you lose rural hospitals. For a lot of small towns, from 
Hawaii to the Dakotas, to the Carolinas, and everywhere in between, the 
rural hospital is the economic center of the community. It is often by 
far the largest employer. I want you to understand, if a rural 
community loses its rural hospital, a lot of the working-age folks 
leave. They move to a more urban area.
  What happens is, the elderly citizens also have to leave because if 
you need access to emergency services but you are nowhere near any of 
that care, you are going to have to go too. So there is not a single 
thing we can do in the Congress that would harm rural communities 
quicker than what is being done this week by the Republicans.
  I want to be really clear about how much harm is about to be done to 
rural communities, not just rural health care providers, not just 
nurses and doctors and technicians and admins and janitors and 
everybody who works at those rural hospitals.
  That is important because in a lot of instances, that is the economic 
driver of a small town. It is also about, people start to make choices 
with their own life and with their own planning, especially as they get 
older, and they think to themselves: How do I stay close to health 
care? If that rural hospital goes away, that rural town goes away.
  We have seen it in Hawaii. That is why we fight for Molokai Community 
Hospital. That is why we fight for Lanai Community Hospital. That is 
why we fight for Waianae Coast Comprehensive Treatment Center. That is 
why everybody fights so hard for their community rural hospitals--
because it is the center of a community, not just economically, but 
without it, you basically have no community.
  All of this will cause the entire insurance market to unravel, 
raising costs for everyone. This means families are going to pay more 
for prescription drugs, pay more on their premiums, and pay more for 
out-of-pocket costs.
  So if the Republicans are still unfazed by the health impacts of the 
repeal I just outlined, and have been outlining for the last 4 or 5 
hours, over the last 3 or 4 days, there is another reason to be 
extremely cautious about what is about to happen. As we know, the 
vehicle for this is a budget resolution, right? They are trying to 
characterize this as, no, it is not a budget resolution.
  The only reason they are doing it as a budget vehicle is so they can 
do reconciliation. What does that mean? That means they only need 51 
votes, where otherwise they would need 60 votes, but this is a budget. 
If it were not a budget, they would not be subject to the 51-vote 
threshold. This is the Federal budget. This Federal budget increases 
the deficit by trillions of dollars.
  This Federal budget increases the deficit by trillions of dollars--
not trillions of dollars at a flat line with the previous Federal 
budget, this is trillions of dollars more than last year's Federal 
budget.
  So if you are a fiscal hawk, gosh, you must be swallowing hard over 
the next couple of days. This must be a bitter pill to swallow because 
on the one hand, boy, do you hate ObamaCare. On the other hand, boy, do 
you hate running up the national deficit--not the debt, deficit--by 
trillions of dollars. This is insane. This deficit--what we are doing 
to the debt and deficit in the next 2 or 3 days makes everything that 
we have done in the last 3 or 4 years pale in comparison.
  If you are a fiscal hawk, I cannot see how you get to yes on this. 
You cannot vote to increase the national debt by trillions of dollars 
and then still call yourself a fiscal hawk. So we have a choice in 
front of us. Do we build on the progress of the Affordable Care Act or 
do we strip millions of Americans of their health care coverage, leave 
those with preexisting conditions out in the cold, and raise the 
national debt?
  We know ACA has its flaws. No one ever said it was perfect. Let us be 
clear. Every major piece of legislation, every signature piece of 
legislation that this body has ever passed has been flawed in some way. 
What do we do when we are a functioning world's greatest deliberative 
body? We iterate it. We work on a bipartisan basis to fix it. That is 
what we should do.
  The benefits of ACA are undeniable. That is what we should be 
debating, improvements to the ACA, not an implosion. So let's keep our 
eye on the ball and remember what our common goal is: giving every 
American the opportunity to get quality, affordable health care they 
deserve.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Sasse). The Senator from New Jersey.
  Mr. BOOKER. Mr. President, the hour is late, even though you look 
like you have a lot of work there to do, sir. I think I am going to be 
merciful and keep this short. I want to thank the Senator from Hawaii, 
the senior Senator from Hawaii, for his remarks.
  I just want to wrap up. We have had multiple speakers now driving 
home a number of points. Two of them I just want to reiterate, which is 
the fact that as I look at a lot of more moderate and conservative 
outlets, from the American Enterprise Institute all the way to the 
American Medical Association, that did not support ObamaCare in the 
first place, you have this chorus growing of responsible, thoughtful 
people who said: Hey, we may want to repeal ObamaCare, but to do it 
without putting up a plan and showing the American public what you are 
going to replace it with is not only contrary, obviously, to a lot of 
the political rhetoric we heard during the campaign season, but it is 
against the logic, it is not prudent, it is actually reckless, and it 
is going to hurt a lot of people.
  This is what we have to understand. I say it is akin to pushing 
someone off a ledge and telling them, as they are falling down, that, 
hey, we are going to get a plan, don't worry. The problem is, people 
are going to get hurt in the interim. The cost of medical care, not 
having that kind of business certainty that you need, it is going to 
spike markets and make things very difficult.
  I just want to say that this body, which I respect--and I am happy to 
hear voices like Senator Rand Paul and others on the Republican side 
begin to come out and say that we should not be repealing this without 
replacing it. I want to offer my gratitude to them because I think 
there are a lot of people--I even heard Chuck Schumer say himself that 
he is ready to roll up his sleeves and talk about ways to improve this.
  We have heard from the President-elect, saying that he is going to 
have a health care system that is better and that costs less. I think 
he used the word ``terrific'' to describe what he is going to bring to 
the American people.

[[Page 459]]

  Well, where is it? Where is the plan? What is the idea? Because there 
are too many people right now in our country who are fearful of what 
might happen. When I say ``fearful,'' it is a base fear; for example, 
some people from my State of New Jersey. This is Martha, who lives in a 
town called Montclair--not quite the same town that the Senator from 
Hawaii was speaking of before, which I cannot pronounce yet. I hope he 
will help me with that. Mahalo; is that right? I am doing all right.
  But this young lady from Montclair very dramatically writes:

       I want to take a moment to thank you for fighting as hard 
     as you have to protect those of us who are disabled and 
     vulnerable to financial ruin, medical crisis, and debt if the 
     ACA is repealed. I am a psychotherapist in private practice 
     for over 20 years. I have served my community by keeping one-
     third of my caseload no fee or low fee for those who have had 
     no insurance.
       For over 20 years, I have purchased my insurance privately 
     and paid dearly for my medical coverage. Two months ago, I 
     was diagnosed with an extremely rare cancer in my central 
     nervous system. I am fortunate that doctors believe that it 
     can be controlled, but not cured, by my taking a low dose of 
     oral chemotherapy for life. I now, as a result of this 
     condition, have zero chance of being able to afford 
     reasonable medical coverage purchased from an unregulated 
     open market.
       My life, literally without hyperbole, depends on my being 
     able to maintain continuity of care and insurance regulations 
     that eliminate exclusions for preexisting conditions. My 
     energies are limited due to my illness. So I thank you for 
     doing all you can to fight for my life and my family. The 
     idea that people with preexisting conditions aren't 
     contributing to the economic health of our country is a 
     distortion. I personally address gaps in our health care 
     system as a provider by sliding my scale.
       The safety net is us, and if I lose my health coverage and 
     can no longer afford it, I will no longer be able to afford 
     to devote one-third of my caseload to those who cannot afford 
     it. It becomes a profound domino effect.

  That is where we are right now. I have heard so many of my 
colleagues, Republican and Democratic, speak to the things they like 
about ObamaCare or at least they like in the abstract, not giving 
ObamaCare any credit. They like the fact that people with preexisting 
conditions can get insurance. They like this idea that there will be no 
lifetime caps. That means that a child who might have leukemia and 
beats it and then becomes an adult can't find insurance because nobody 
wants to insure him because they have exceeded these ideas of lifetime 
caps. They have gotten rid of this idea that you cannot stay on your 
parent's insurance just because you have turned 23, 24. Now you can do 
it until you are 26. There are so many aspects of ObamaCare that people 
say they like. One thing that even Republican Governors talk about 
liking is just the idea of Medicaid expansions that have occurred in 32 
States and have enabled millions of Americans, hard-working families, 
their children, people living in nursing homes, those who suffer from 
addiction, and the poor and the underserved, to get access to quality 
health care.
  That is what is incredible. We have people who are coal miners and 
sick who have benefited from this. We have folks who are in nursing 
homes who have benefited from this. We have folks who are suffering in 
this opioid crisis with addictions who have been able to get access to 
coverage and access to care. More than this, we have now created a 
system that equates and understands that mental illness and physical 
illness is in parity--that insurance companies have to offer that as 
well.
  In addition to all of that, we now have a system that says to anybody 
that you cannot be denied for the kind of reasons you were denied 
before and find yourself falling into the trap that so many Americans 
did; that the No. 1 reason--or at least one of the top reasons people 
were declaring bankruptcy was because they could not afford their 
medical bills. These are all things that are universally--or at least 
the overwhelming majority of Americans want.
  So we all agree on many of the basic goals. The question is, How do 
get there? It has been indicated by the President-elect and others that 
they have a plan to get there, to preserve all of these things that are 
now being savored by Americans, that are literally, as Martha from 
Montclair points out, saving people's lives. The question is, How are 
you going to get there? By the way, if you try to shortcut it and don't 
tell us how you are going to get there and just repeal ObamaCare, then 
you introduce uncertainty to the market. Insurance companies are 
speaking up. The American Medical Association is speaking up. The 
American Diabetes Association is speaking up. The American Cancer 
Society is speaking up. All of these nonpartisan or maybe even 
conservative folks are speaking up, saying: You can't do the repeal 
unless you put forward what you are going to replace it with.
  Free market folks know you don't introduce uncertainty into the 
markets without consequences, and those consequences would be a 
disruption to the individual marketplace, the spiking of prices, people 
pulling out, and that death spiral.
  I believe in the prudence of this body. I have seen it from people on 
both sides of the aisle--the thoughtfulness that they won't rush to 
embrace a pure political victory at the expense of real people. Well, 
this is one of those moments.
  What are we going to do as a body? Are we going to repeal and not 
replace? Or are we going to have a great discussion about what that 
replacement will be?
  So tonight we have heard from a lot of my colleagues. I am really 
proud that folks have taken to the floor. I am even more proud that, 
from my office, we are hearing from people on both sides of the 
political aisle. Not everybody likes ObamaCare. Not everybody voted 
Democratic. It is people from both sides of the aisle. They do not 
understand why we would rush forward doing the repeal without the 
replace.
  I want to thank everybody who has spoken tonight. The hour is late, 
and I just want to thank a lot of the folks who don't normally keep 
these kinds of hours. There are some pretty incredible people who work 
up around the President's desk.
  We have a lot of pages here who do not get enough thanks on both 
sides--Republican pages and Democratic pages. I want to thank them, as 
well, for staying late, even though, technically--and I hate to call 
them out on this--if they have to stay up past 10 p.m., they don't have 
to necessarily do their homework and show up for school the next day. 
That is what I hear. So we might have done you a favor. But either way, 
I want to thank everybody tonight.
  Mr. President, I want to suggest the absence of a quorum.
  Oh, I am sorry. I want to--what do I want to do? I want to just drop 
the mic.
  Mr. SCHATZ. That is the first time the Senate has ever ended with 
that one.

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