[Congressional Record (Bound Edition), Volume 163 (2017), Part 10]
[Senate]
[Pages 15069-15073]
[From the U.S. Government Publishing Office, www.gpo.gov]




               HEALTHCARE, THE DREAM ACT, AND TAX REFORM

  Mr. VAN HOLLEN. Mr. President, we had some good news--or I should say 
the American public had some good news today in the announcement from 
the Republican leader that the Senate will not be proceeding to debate 
what is known as the Graham-Cassidy legislation, the latest version of 
TrumpCare, which would have had a devastating impact on our healthcare 
system and created harm throughout the country and in my State of 
Maryland. In fact, I know millions of Marylanders will be breathing a 
sigh of relief as a result of this decision.
  Mr. President, I ask unanimous consent to have printed in the Record 
the personal testimonials of Marylanders who, in the last few days, 
have sent to me their very powerful stories about how the Graham-
Cassidy legislation would have harmed their loved ones.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:


             Van Hollen Constituent Healthcare/ACA Stories

                               9/19/2017

       ``I am a Registered Nurse who specializes in perianesthesia 
     care. Please do not wind back the clock and make it harder 
     for people to seek care during an illness. I am heartbroken 
     that I have cared for patients who delayed care for weeks and 
     months because they were more afraid of medical bills than 
     dying. When people are ill and do not seek care, they 
     jeopardize their lives--and in the case of communicable 
     diseases they jeopardize the lives of others by delaying care 
     and treatment.''--Beth
       ``My 14 year old daughter is a leukemia survivor. She has 
     multiple serious long term side effects from her chemotherapy 
     regiment. By repealing Obamacare, she becomes uninsurable due 
     to her preexisting conditions and the fact that she has met 
     her life time maximum many times over.''--Caroline
       ``I have a neuromuscular autoimmune disease called 
     Myasthenia Gravis. It affects my voluntary muscles, muscles I 
     use to walk, carry my groceries, see, swallow and breathe. I 
     already have to fight with my insurance to get them to pay 
     for my immunoglobulin infusions, which most of the time they 
     deny, which sends me to the emergency room because I can't 
     breathe. If for any reason I have to find a new insurance, 
     such as my husband getting a different job, it could be a 
     death sentence for me. Just one month of outpatient 
     immunoglobulin therapy is $27,000. My immunosuppressants I 
     have to take daily can run up to $2000 for a 3 month supply. 
     Then couple my health issues and the cost of medications and 
     I would probably die within a month or less. I didn't ask to 
     get sick. I never imagined at 41 I would be facing my 
     mortality.''--Chrissy
       ``My older sister has been profoundly disabled by mental 
     illness for the last 50 years. She is 62 now. She has severe 
     behavioral issues She cannot work. . . . She has been one 
     step from living on the street if it weren't for Medicaid and 
     SSDI. She is not getting rich from these safety nets by any 
     means. If these go away the republican congress and this 
     presidential administration will be responsible for making 
     challenging lives that much more miserable We don't treat our 
     most vulnerable as if they are disposable.''--Cat
       ``My son, 6, has a complex congenital heart defect called 
     Hypoplastic Left Heart Syndrome (HLHS). He has had four open 
     heart surgeries and several cardiac catheterizations. A 
     transplant could be needed one day. I worry every day about 
     how he will have heart care should something happen and when 
     he is too old to be on our plan.''--Dara
       ``I am a nurse practitioner and worked for the VA 
     Healthcare System for 15yrs. While this system is not without 
     its challenges, without it, many of our veterans would not be 
     receiving the healthcare and support they need to remain 
     healthy and productive members of society They would not be 
     able to work and support their families and as a result, 
     would likely not seek healthcare until they needed emergency 
     services. By then their previously untreated condition may 
     already have worsened to the point of permanent disability or 
     death, leaving their families to fall into poverty, despair 
     and having to rely on Gov't. Assistance. If they do not die, 
     their disability care costs far more than the early and 
     maintenance treatment they should have been receiving even if 
     they needed this maintenance treatment for a lifetime!''--
     Becky
       ``My 25 yr old son has Crohn's disease. His entire large 
     intestine was surgically removed when he was 17. He must get 
     a remicade infusion every 6 weeks to keep his immune system 
     from attacking his intestines. No hospital ER will administer 
     his remicade infusion as this is considered maintenance of 
     his disease. When his situation becomes life threatening and 
     he needs the Intervention of the ER . . . the damage is 
     already done. Why don't our republican senators get this? 
     Shouldn't they be aware of this. . . . if they think they are 
     the experts, representing us? Trey will lose his insurance 
     next June when he turns 26.''--Darlene
       ``Deep Medicaid Cuts would be devastating to the millions 
     of people with disabilities. The Home and Community Waivers 
     would be in jeopardy. Because of the Community Pathways 
     Medicaid Waiver, Our 32 year old son is able to live in his 
     own apartment, volunteer in the community, hold a 30 hr week 
     job in Gaithersburg, and have a social life. Without the 
     supports he would lose his independence. . . . Please don't 
     make deep cuts to Medicaid.''--Reda
       ``We have 14 year-old twins, both of whom have Cerebral 
     Palsy. . . . It isn't their fault that they have a disability 
     and they should not be punished for it.''--Danica
       ``I work with medically fragile children with disabilities. 
     Without Medical Assistance, these children and their families 
     cannot afford the equipment, supplies & therapies that help 
     them grow and thrive.''--Carmel
       ``I'm 48. I was diagnosed with scoliosis at age 13, and I 
     had spinal fusion surgery to save my life from it at age 21. 
     The surgery saved my live, but also had lifelong 
     consequences. I have had this pre-existing condition for most 
     of my life. My parents, and then me when I came of age, have 
     always had to be careful to make sure that pre-existing 
     conditions were covered. I once turned down a job in part 
     because their insurance didn't cover pre-existing conditions. 
     The ACA meant I no longer had to worry. Today, I work as a 
     contractor for the US military, helping defend US cyberspace. 
     I wouldn't be here, doing important work and being a 
     productive member of society, if I couldn't get coverage for 
     my pre-existing conditions.''--Bruce
       ``Obamacare saved my roommate's life. He was a server at a 
     very popular restaurant, hardworking, got good tips but could 
     not afford health insurance. He got prostate cancer. 
     Obamacare got him the care he needed.''--Deborah
       ``I had a mitral valve prolapse. It was discovered when I 
     was a little girl, and basically that means that one of the 
     valves in my heart never fully closed. I was followed 
     annually by a cardiologist, and she told me to expect to have 
     it fixed in my 30s. She also told me to have children in my 
     20s because if I needed to have it replaced (not just 
     repaired), I would need to take blood thinners that would not 
     allow me to be pregnant. I had my heart repaired four days 
     after my 30th birthday, when my kids were 5 and 9 months. It 
     was not fun, especially being a mom with little ones, but I 
     am as good as new five years later. Only my health insurance 
     doesn't think so. Prior to the ACA, I was rejected by the 
     BCBS policy my husband's company was providing for us and his 
     employees. They told us they were happy to offer coverage for 
     my family but would not include me on our plan. Everyone gets 
     sick. Everyone gets old. You can do everything right and take 
     care of yourself--and still have a preexisting condition that 
     makes you more expensive to cover. And without the ACA, I may 
     find myself having to fight for health insurance again.''--
     Justine

[[Page 15070]]

       ``My daughter was diagnosed with a rare Autoimmune disorder 
     at age 18. . . . Thanks to Obamacare, she was able to stay on 
     our insurance until age 26 then purchase her own through her 
     employer. Preventative care keeps her in remission. Losing 
     the ability to afford insurance means she cannot afford care. 
     One medication alone costs over $2,000/month!''--Cheryl
       ``I am the first to acknowledge that there are major 
     problems under the ACA. Premiums and deductibles are far too 
     high and increasing far too much annually. I am self-employed 
     and the individual market is getting exceedingly worse each 
     year. CareFirst proposed a 50% rate hike for 2018 for plans 
     that already have a $6500 deductible. This is not 
     sustainable. However, prior to the ACA, I was denied coverage 
     by every insurer in the State of Maryland. The reason for the 
     denial was that I was prescribed Lovenox, an injectable blood 
     thinner, when I was pregnant with my three children. The 
     letters denying coverage said I was at increased risk for 
     thrombosis, despite the fact that I had medical documentation 
     stating otherwise because my particular blood clotting 
     concerns exist only in pregnancy. Before the three children 
     in my profile picture were born, our first daughter was 
     stillborn and I had two miscarriages. Initial pathology 
     following her stillbirth showed that the placenta was badly 
     clotted and blood testing showed that my Protein S levels 
     were low. Following the two miscarriages and substantial 
     blood work, my doctors concluded that my protein S levels dip 
     to deficient levels in pregnancy and that I needed blood 
     thinner in order to maintain a pregnancy. I find it ironic 
     that the ``pro-life'' Republican party wishes to punish me 
     and my family because of medication I took to ensure that my 
     children were born alive and well. We need to fix the ACA, 
     but this is not it.''--Kim
       ``I have been a type I diabetic for 25 years. When my 
     husband and I had health insurance coverage through his 
     employer, my prescription for life-sustaining insulin cost us 
     $300 each month. After he began working for a new employer 
     who did not offer health insurance, we were encouraged to 
     shop for our healthcare on the Maryland Exchange. With our 
     ACA plan, my insulin is now much more affordable at $50 a 
     month. If I have to go back to paying exorbitant amounts of 
     money for a medication I need in order to survive, I will be 
     forced to cut corners. If I do not take the necessary amount 
     of insulin, I face a host of complications including kidney 
     failure, neuropathy, blindness, and so much more. My husband 
     and children should not have to watch me suffer the 
     preventable side-effects of this disease. Like all other 
     Americans, I deserve affordable health insurance coverage and 
     the Affordable Care Act provides that for me!''--Katie
       ``I am a 55-year-old humorous, fun-loving, and fiercely 
     idealistic daughter, sister, friend, 5th grade teacher, 
     volunteer, advocate, and 9 year breast cancer SURVIVOR. 
     Please!! Do not allow them to change the words ``breast 
     cancer survivor'' into something I loathe and fail to 
     celebrate!! If the GOP is successful, which I CANNOT bear to 
     consider, I become no more than a ``preexisting condition and 
     cancer VICTIM'' in the eyes of our government, insurance 
     companies, and the healthcare system. If the GOP is 
     successful, I become a 55-year-old angst-ridden daughter, 
     sister, friend, 5th grade teacher, volunteer, advocate, and 
     SCARED AS HELL breast cancer VICTIM who fears bankruptcy and 
     spends countless hours contemplating my mortality. Please!! 
     Keep fighting for all of us. I sincerely believe that 
     EVERYONE IS A SURVIVOR--NOT A VICTIM--OF SOMETHING IN THIS 
     LIFE!! Please!! Do not let the GOP take control of our 
     narrative. We all have people who count on us. If we cannot 
     take care of ourselves because of sky-rocketing medical costs 
     . . . If we cannot function in our jobs properly because of 
     constant fear and worry. . . . How can we possibly take care 
     of our beloved family, friends, and those in our care both 
     professionally and in our volunteer endeavors???''--Carla
       ``Thank you for fighting this. I am a 7\1/2\ year cancer 
     survivor, but could be prohibited from coverage if my 
     previous diagnosis is included in pre-existing condition 
     exemptions.''--Pat
       ``My daughter is medically fragile, and dependent on a 
     ventilator, due to a genetic condition (Neurofibromatosis 
     type 1, also known as NF). She also has a rare 
     cerebrovascular disorder, called Moyamoya Disease that caused 
     her to suffer two strokes at age 15 months old. Daphne has 
     been through heart surgery, neurosurgeries, chemotherapy, and 
     countless hospitalizations. She also suffers from epilepsy. 
     Because of her vast health issues, she requires 24 hour care 
     and receives in-home nursing through Medicaid for 16 hours a 
     day. Cuts to Medicaid coupled with allowing insurers to deny 
     for pre-existing conditions, and bringing back high-risk 
     pools would put the most vulnerable people at risk. . . . 
     Every ACA repeal bill that has come forward has been a threat 
     to my daughter's wellbeing, and this one is no exception. 
     This is not the right path forward. The Senate should be 
     working hard to make sure every American has access to 
     healthcare, every Senator should be looking out for the most 
     vulnerable Americans. There are measures needed to improve 
     our healthcare system; but cutting access to healthcare to 
     the people who need it most is not an improvement. For 
     families like mine, it would be devastating.''--Jenny
       ``In 1994, I was 24 years old and working at Dartmouth 
     College in New Hampshire, when I suddenly got very sick and 
     was hospitalized. I was diagnosed with acute pancreatitis of 
     unknown cause, and spent 11 weeks in the hospital and had 2 
     surgeries. I did have health insurance, but the final costs 
     from that initial illness that were billed to insurance 
     totaled over $250,000. Two years later I experienced a 
     recurrence of the pancreatitis, and I was told that I now was 
     almost assuredly going to have what is known as Idiopathic 
     Recurrent Acute Pancreatitis. This time I was only 
     hospitalized for 30 days, but the costs were mounting, and I 
     began to be afraid that I was going to easily hit the one 
     million dollar lifetime limit that was currently part of my 
     policy. I also was unable to consider moving away from New 
     Hampshire (to be closer to family resources and support, for 
     example), because of the strict Pre-existing Conditions 
     clauses at that time. In 1998, when President Clinton signed 
     the bill that forbade insurance providers from denying 
     coverage for preexisting conditions, I was able to change 
     jobs and move back to my hometown of Baltimore, Maryland. 
     Now, after working for The Johns Hopkins University for 15 
     years, I have been forced by necessity to leave my job and 
     obtain Social Security Disability benefits, and now I am also 
     being covered primarily by Medicare. I am already living on a 
     fixed income, at age 47, and I am not making enough money to 
     even live without a roommate, let alone enough money to face 
     increasing premiums as well as decreasing coverage for my 
     medical care. Please, please, please do not let Congress pass 
     this bill!! I would be honored for you to tell my story, and 
     I hope that maybe it could be eye-opening for some of the 
     representatives who seem to believe that if you are a well-
     educated, younger, tax paying citizen these changes won't 
     have a big impact. This kind of unexpected medical disaster 
     could happen to anyone.''--Nicole
       ``11 months ago, I had to consent to a C-section at 28 
     weeks pregnant due to pre-eclampsia. The only thing worse 
     than having to put my tiny son's health in jeopardy to save 
     my life was the fear of my dying and leaving my husband to 
     raise a 4 year old and a potentially medically-fragile 
     infant. Now I worry, will his prematurity and my high blood 
     pressure come back to haunt us? I got through his 142 day 
     stay in the NICU by dreaming of what his life could be. I 
     dream of him running when he is two, arms outstretched, of 
     when he is 22 and graduates from college, maybe to be a NICU 
     nurse, of when he gets married and I dance with him. . . . My 
     nightmare is that this will affect our ability to have that 
     future I dreamed of, mostly that I won't be there for him. We 
     have fought so hard to get our own ``normal'', please keep 
     fighting for us.''--Rachel
       ``I am a Montgomery County Maryland resident and have an 
     aged severely disabled aged brother in a nursing home who 
     depends on Medicaid and an adult daughter with Crohn's 
     disease and a preexisting condition she acquired as a 
     teenager and both of their lives will be put in jeopardy if 
     they lose their current . . . medical coverage and I am 
     worried and angry at the cruel and heartless Republican 
     attempt to reduce or eliminate their life saving health 
     coverage.''--Richard
       ``My husband and I have both have had life threatening 
     medical conditions. To lose our health insurance due to pre-
     existing conditions will be a death sentence when we run out 
     of options. I worry most though for our medically fragile 
     children and seniors.''--Val
       ``Twelve years ago, before the Affordable Care Act, I was a 
     single parent of two school age children and was denied 
     health insurance coverage because of pre-existing conditions. 
     I frantically searched for employment where I could have 
     coverage in an employer plan. I was fortunate to find this. . 
     . . In 2014 I had to leave employment to become a care giver 
     for my husband who was diagnosed with Parkinson's disease. I 
     considered myself fortunate to be able to do this because the 
     Affordable Care Act would allow me to purchase health 
     insurance without worrying about my pre-existing conditions. 
     My premiums and deductibles have been very expensive, but at 
     least I could obtain coverage. I remember the stress and fear 
     from being previously denied coverage.''--Roberta
       ``My 25 year old daughter is about to hit her 90-day 
     sobriety date, thanks to her hard work, and the treatment she 
     is receiving at a great rehab in PA. She is still going to 
     outpatient, and she is living in a sober house with 
     roommates. My health insurance has covered her treatment. 
     Thank God she is still able to be covered under our family 
     plan. Please do not take the chance for a life in recovery, 
     and addiction treatment services away from our children It is 
     saving lives.''--Deb
       ``It would be a death sentence for me. As it is now I am 
     fighting to get on disability now. I have 4 serious pre-
     existing conditions. The ACA saved my husband's life no joke 
     as he had cancer life threating cancer and without it he 
     would NEVER had survived period. He also has 3 other 
     preexisting conditions. Our medical bills as it stands now 
     are more then

[[Page 15071]]

     all our other bills combined per month. In the middle of an 
     opiate epidemic as well OMG addiction and or mental health 
     issues are considered pre-existing conditions what are they 
     thinking and ripping millions of people safety net away from 
     them in the middle of this crisis is not human.''--Jean
       ``I have asthma, which was and is a pre-existing condition. 
     Early in my twenties when I was in college but not able to be 
     on my parent's insurance, I would put off going to the doctor 
     because I couldn't afford it when I got sick. Consequently, 
     this meant I ended up in the ER for asthma related problems. 
     Every 6 months I would come down with pneumonia because there 
     was no vaccine for it then, and each time it meant a visit to 
     the ER for intensive breathing treatments because I could not 
     breathe. This happened so many times I eventually had to 
     declare bankruptcy to get out from under the bills. Today my 
     asthma medicine is covered with a nominal co-pay, I can see 
     my doctor before a case of bronchitis becomes something 
     worse, and I do not need to go to the ER for treatment. Now I 
     have a twenty year old in college who has pre-existing 
     conditions, unlike me she is still covered under our health 
     insurance and her prescriptions are affordable. What happens 
     to me, my daughter, and my husband who all have pre-existing 
     conditions if our insurance is allowed to go back to the old 
     days of charging more for our coverage? What happens to my 
     daughter if she can no longer be on our policy? Surely the 
     Republicans can't think that repealing these protections and 
     replacing them with nothing is something good for our 
     country? Are they that out of touch with the middle class? 
     Please do not pass this, you will be hurting many, many 
     people.''--Pamela
       ``As a type 1 diabetic, I used to skimp on my insulin to 
     make the bottles last longer. Keeping my blood sugar levels 
     higher than they had to be is catastrophically unhealthy. 
     Please don't make people with chronic illnesses have to 
     choose between food and medicine!''--Sandra
       ``My sister who has Cerebral Palsy and is able to live at 
     home at the age of 41 with my parents would lose the medical 
     coverage and supports that ensures her wellbeing. My father 
     who is 87 years old would now be subject to pre-existing 
     condition exclusions. This is a man who served in the army 
     and retired from the Postal Service in his 70's. He grew up 
     in the Great Depression and worked tirelessly his entire 
     life. Name me one person who does not have a pre-existing 
     condition by the age of 87.''--Bonnie
       ``My daughter has had pre-existing conditions since she was 
     22 months. She is now 23, still with developmental delays and 
     chronic medical conditions. She will need good care and 
     Medicaid and a Medicaid waiver program the rest of her life. 
     She will never be able to work. If there are cuts to Medicaid 
     and she gets denied private insurance for pre-existing 
     conditions, our government is basically telling me and 
     telling her, ``We really don't want her to live. We really 
     only want healthy and non-disabled people living in America. 
     We would like her to die.'' That is exactly what their plan 
     sounds like to me.''--Kimbell
       ``I am guilty of being born with an autoimmune condition. 
     For much of my young adult life I was not insurable because 
     of the pre-existing condition clause, and arthritis caused by 
     my autoimmune condition left me stuck in bed more days than 
     not. Since the ACA, I am insured and as a result have been 
     able to start a treatment for my condition which is literally 
     life-changing. I can leave the house, I can have a normal 
     life, and I'm even fostering a dog for a rescue that took 
     dogs from the Harvey shelters before the storm, to make room 
     for displaced pets. He needs a walk every day, at least once 
     a day, and I can do that. The repeal makes no sense--if I can 
     buy insurance I can work and contribute to the community. If 
     I can't get insurance I can't get healthcare, and without 
     healthcare I can't work, I can't contribute to society 
     through volunteering--how do people benefit from making sure 
     people like me can't get the healthcare we need to be able to 
     have lives? Even if you don't care about us as people, 
     society benefits when more people can work and pay taxes and 
     volunteer.''--Kris
       ``In 2006 at age 41, I was diagnosed with a rare, incurable 
     and life-threatening disease. I had insurance through a 
     Health Savings Account, which had a $3,000 annual deductible 
     and monthly premiums that increased 400% in 5 years. I've 
     been disabled by this illness and many complications and rely 
     on Medicare and Medicaid to survive. If either is cut I won't 
     be able to afford the highly specialized medical care this 
     rare disease requires. I will die as a result. Please do 
     everything in your power to protect all of us whose lives are 
     at risk.''--Sangye
       ``My Wife's Father, Dennis, passed away a little over two 
     years ago of congestive heart failure. He wasn't even 60. He 
     was a CT Native that lived alone in SC with just his beloved 
     German Shepheard Bobbi at his side. While his medical issues 
     were great, he managed to hide most of them from the family. 
     . . . Had he gotten treatment early his conditions could have 
     been easily managed but because he went untreated for years, 
     his issues became fatal. There was eventually nothing that 
     could be done. The saddest part of this is that we fought 
     with him for years to sign up under the Affordable Care Act. 
     He refused because he felt this was a hand out and he was too 
     proud for that. When he eventually became too weak to carry 
     out even the most basic tasks, which included hiding his 
     condition from the family, he finally agreed to sign up. 
     While he did sign up, he would never see his first 
     appointment. He passed in his sleep before it could even be 
     scheduled. . . . Dennis should have lived. He could have 
     lived. If he simply had access to the care he needed all 
     along then he would still be with us. But we don't get to 
     have that. Instead my Wife has a hole in her heart that may 
     never be repaired. Tormented with the ``what ifs'' that can 
     never be answered. The only thing we can be thankful for in 
     this is that we were able to claim Bobbi, the dog he lived 
     for. She has become a truly beloved member of our family.''--
     Jason
       ``Thank you for fighting for us. If pre-existing conditions 
     aren't covered I will quickly go bankrupt. I will lose my 
     house that I just purchased. I have a good, steady job and a 
     Master's degree but this would quickly bankrupt me.''--
     Rebecca
       ``People need to understand how easy it is to feel like a 
     relatively healthy person, then be saddled with a ``pre-
     existing condition''. I work in a field where it is difficult 
     to get employer sponsored health insurance. Before the ACA, 
     when I was applying for my own policy. . . . I had to go 
     through underwriting. They called every doctor I ever had. 
     They requested that my entire file be sent to the insurance 
     company. It was very invasive. . . . Finally, I received a 
     letter. I do not qualify for insurance due to pre-existing 
     conditions. I have never been seriously ill, never been 
     hospitalized. I use an asthma inhaler as needed and I take 
     one generic pill every day for another condition. This was 
     enough to deny me. I had to go on a high risk plan which cost 
     me almost as much as our ACA plan for a family of three. 
     There was no drug coverage whatsoever. I had to pay list 
     price for drugs. . . . I had a well-paying job with no 
     dependents and I still needed help from my parents to pay for 
     all of this. . . . With this new bill, these are the days we 
     are going back to. We can't. We just can't.''--Hilary

  Mr. VAN HOLLEN. Now that we have decided not to vote on that 
legislation, it is essential that this Senate move forward 
expeditiously to take up bipartisan legislation that has been in the 
works through Senator Alexander and Senator Murray. Those conversations 
were bearing fruit. They were productive until the Senate decided to 
veer off, once again, to try to pass legislation that would have 
destroyed the Affordable Care Act. But now that we have decided not to 
go down that path, we have to quickly come back to those bipartisan 
talks and adopt some commonsense measures to strengthen the insurance 
system in a smart and targeted way.
  There were many commonsense ideas that are part of those discussions, 
including making more permanent the so-called cost-sharing provisions, 
which help to lower the costs of healthcare and help to reduce the 
premiums, the copays, and the deductibles, and the reinsurance 
provisions that also have that effect, as well as discussions about how 
we might be able to streamline waivers within the Medicaid system 
without sacrificing or jeopardizing the important principles and 
protections that Medicaid provides on a national level.
  We know we have to move quickly on this front because insurance 
companies all over the country have already started or are on the brink 
of starting the process of announcing their premiums. Unless this 
Senate takes action, we are going to see many high premiums. So we have 
to move quickly. As we do, the White House needs to stop their efforts 
to undermine and sabotage the Affordable Care Act.
  On day one of his Presidency, President Trump adopted an Executive 
order that began to sabotage that program. We are already seeing the 
impact when it comes to some of the early premium announcements we have 
seen from insurance companies that offer insurance in the exchanges. 
That decision--that early Executive order--has created a big spike. So 
the President needs to act right away to assure the folks who provide 
healthcare throughout the country that he is going to stop the sabotage 
and begin to make sure that we stabilize those markets. It is under his 
control to say today, if he wanted, that he will continue those cost-
sharing payments until the Senate and the House adopt permanent 
legislation to address those issues.

[[Page 15072]]

  So it is really important that the Trump administration take those 
actions now to avert increasing premiums in the exchanges in the days 
to come. It is also essential that the Senate move forward on that 
legislation.
  I hope we will also move forward with the continuation and some 
strengthening and modifications of the Children's Health Insurance 
Program. Again, there is bipartisan agreement on that proposal. We need 
to move forward right away with the support for community health 
centers because that authority will also expire.
  I hope we will then get on with the business of putting into law the 
agreement in principle that was reached by President Trump and the 
Democratic leaders in the House and the Senate to provide protections 
for the Dreamers. As we all know, the President lit the 6-month fuse on 
these young people who were brought here through no fault of their own, 
and it is incumbent on all of us to make sure that these young people, 
who have grown up knowing only America as their country and who have 
grown up pledging allegiance to the flag, not face the threat of 
deportation 6 months from now. That is what they are facing as of this 
moment. The Senate should act quickly to pass the bipartisan Dream Act.
  I hope we will also move forward in a bipartisan way on the important 
issue of tax reform because I think all of us agree that our Tax Code 
could be simplified. There is a lot of junk in our Tax Code that has 
been put there by powerful special interests who were able to hire 
high-priced lobbyists to exempt themselves from certain tax provisions 
that all other Americans have to pay. We need to clear out that 
underbrush and make other important reforms, and we can simplify the 
Tax Code.
  As we do that, I was very much hoping that we would take the advice 
of our colleague, Senator McCain, who said we need to get back to the 
regular order. We need to get back to the Senate conducting its 
business in a transparent manner. We need to have hearings. We need to 
bring witnesses from all different perspectives and points of view to 
testify as to the impact of tax reform proposals.
  We short-circuited that process when it came to healthcare, and the 
result was a healthcare bill that the overwhelming majority of the 
American people rejected, including every single patient advocacy 
organization that weighed in on that bill--from the American Cancer 
Society to the American Heart Association and the American Diabetes 
Association. We have seen that very long list, with all of the 
healthcare providers, from the nurses to the doctors to the hospitals. 
Hospitals in rural areas, suburban areas, and urban areas all said that 
the healthcare bill that did not go through the regular process and did 
not go through the regular order was deeply flawed and would hurt 
America.
  We should learn a lesson from that. The lesson we should learn is 
that tax reform, which also has an incredibly wide-reaching impact on 
our economy and on our country, should go through the regular order of 
debate. It is very alarming to see that, as of now, it appears that the 
process on tax reform is going to go through the same short-circuited 
effort as we saw with respect to healthcare, because what we have seen 
is that the Senate Budget Committee, on which I am proud to serve, will 
soon--maybe as early as next week--be taking up a budget bill that will 
include what are known as budget reconciliation instructions, which 
would provide for a tax cut that would be deficit-financed. What does 
that mean? It means that we would be cutting taxes and not paying for 
them. We would be cutting taxes and putting it on the American credit 
card and, as a result, dramatically increasing our debt. In fact, the 
reports indicate that the proposal will actually green-light a $1.5 
trillion increase in the Federal deficit.
  Now, I have heard our Republican colleagues in the House and in the 
Senate for years talk about the fact that the debt is a huge burden 
overhanging on our economy. The debt is a big problem, and we need to 
deal with it. In fact, a few months ago, Leader McConnell said that any 
tax overhaul plan would ``have to be revenue-neutral'' because of the 
``alarming $20 trillion Federal debt.'' Yet, just months after that 
statement, we are told that we are probably going to get a proposal 
that would actually green-light--open the door--to increasing the 
Federal debt by $1.5 trillion in order to provide a tax cut.
  Now, the Democrats have put forward some principles for tax reform 
that I believe reflect the views of the American public. What we have 
said is this. No. 1, tax reform should be there to help the middle 
class and working families with some relief, and we should not be 
providing millionaires in the top 1 percent with yet another tax cut 
windfall. That should not be the priority of the country. In fact, 
Secretary Mnuchin, when he was testifying during his confirmation 
hearings, put forward something that we called the Mnuchin rule, which 
said that there should be no net tax cut for the very wealthy. So we 
have adopted that as one of our principles for tax reform.
  We have also said what Leader McConnell said a few months ago, that 
tax reform should not add to the deficit and debt. We shouldn't pass 
that burden on to taxpayers and future generations to pay the interest 
on that debt.
  Finally, we have said that it should go through the regular order, as 
Senator McCain indicated, where we have that debate in an open forum so 
that everybody can understand the impact and have their say before 
people try to rush it through the Senate in a short period of time. So 
I hope that is what we will do. These reports that we are talking about 
short-circuiting the process are alarming.
  Then, we just heard within the last few days that, in addition to 
creating a process that would fast-track tax cuts that could go 
overwhelmingly to the wealthy and add to our deficit, this 
reconciliation bill will be written in a way that might allow us to try 
to fast-track the destruction of the Affordable Care Act again. We have 
finished this debate for this fiscal year, but suggestions are that it 
will open the door to destroying the Affordable Care Act through that 
fast-track, so-called reconciliation process in the months ahead.
  So we would have in one piece of legislation a proposal that says: 
Let's cut taxes for very wealthy people, and it will add to the 
deficit, but we are also going to try to reduce the deficit a little 
bit by cutting healthcare for millions of Americans.
  We thought we just had that debate, and we thought the American 
public just weighed in on that debate. The result of the American 
public's weighing in was very clear, and that is why we are not voting 
on that this week in the Senate. We should not open the door again to 
that kind of fast-track process that could do such grave harm to the 
healthcare of the American people.
  So I hope that when it comes to tax reform, we will take a different 
path. As I indicated, there are things we can and should do to simplify 
our Tax Code. What we should not do is what we have seen in the past. 
What we saw in the past in the early 2000s was this fast-track 
procedure used to pass tax cuts that went overwhelmingly to the 
wealthiest Americans. In fact, after that tax cut was put in place, 
what went up was the income of the top 1 percent. What went up was the 
deficit and the debt, and everybody else was left flat or sinking. So 
that would be a terrible mistake.
  For example, we are told that part of this will be eliminating 
entirely the so-called estate tax. Right now, the estate tax only 
applies to estates over $11 million, for couples--over $11 million. So 
0.2 percent of Americans are impacted by the estate tax, and they are 
the wealthiest of the very wealthy. Yet this proposal says we are going 
to actually increase the debt by $1.5 trillion in order to make room 
for tax cuts that benefit the top two-tenths of 1 percent of the 
American public.
  That is heading in the wrong direction. I am pretty confident that, 
at least, in my State of Maryland, the overwhelming majority of our 
citizens would be very much opposed to that effort. What always happens 
is that,

[[Page 15073]]

when it comes to cutting taxes for the very wealthy or for powerful 
special interests, many of our Republican colleagues here forget about 
all the talk about the importance of the deficit and debt. It is OK to 
run up a $1.5 trillion debt on top of our already high debt in order to 
provide tax cuts. But then, when those debts go up, always the 
conversation comes around to cutting--cutting our investments in 
education; cutting Medicare, turning it into a voucher program, as 
various Republican budgets in the House and Senate have proposed over 
the years; cutting Medicaid, which is what the Graham-Cassidy bill 
would have done and, according to the Congressional Budget Office, it 
is over a $1 trillion cut, and that is before it went over a total 
cliff in the outyears.
  So let's, please, colleagues, learn the lesson from how this 
healthcare fiasco unfolded. When it comes to things like tax reform, 
let's proceed in a bipartisan way. Let's begin in the coming week to 
get back to the bipartisan discussions on healthcare, so that as we 
head into the fall, people are not going to experience wounds that are 
inflicted by the lack of action by this Congress--by this Senate and 
this House.
  I thank you, Mr. President. I hope we can get back to regular order 
at some point in time and really do the people's work the way it is 
intended to be done--in an open, transparent, and bipartisan way.
  The PRESIDING OFFICER. The Senator from Iowa.
  Mr. GRASSLEY. Mr. President, I ask unanimous consent to speak for 
approximately 6 or 7 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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